Provider Demographics
NPI:1144687625
Name:DONNELLY, DYENINA DALEON (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DYENINA
Middle Name:DALEON
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DYENINA
Other - Middle Name:SAGUNO
Other - Last Name:DALEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 BURR RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6423
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:630-832-3078
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6423
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:630-832-3078
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily