Individual
DANIELLE VANDERVEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 844-6551
(815) 842-1793
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 844-6551
(815) 842-1793
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004000
IL
Other
Enumeration date
03/03/2011
Last updated
03/03/2011
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