Provider Demographics
NPI:1548646243
Name:ROACH, DANIELLE (APN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SYMONDS DR
Mailing Address - Street 2:#578
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3763
Mailing Address - Country:US
Mailing Address - Phone:630-856-6782
Mailing Address - Fax:630-241-2803
Practice Address - Street 1:109 SYMONDS DR
Practice Address - Street 2:#578
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3763
Practice Address - Country:US
Practice Address - Phone:630-856-6782
Practice Address - Fax:630-241-2803
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily