Individual
SALLIE VAN DAELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-2200
(815) 971-9097
Mailing address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-2200
(815) 971-9097
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209-004897
IL
Other
Enumeration date
12/12/2006
Last updated
07/18/2011
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