Individual
MISS DAYNA NICOLE PORTNOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 CENTRAL AVE, SUITE 200, WILMETTE, IL 60091-2654
(847) 256-1705
Mailing address
380 RIDGE AVE, 14-2, EVANSTON, IL 60202-3357
(847) 905-0654
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
041-265829
IL
363L00000X
Nurse Practitioner
209-006098
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00378000
MEDICARE RAILROAD
IL
05
—
XXXXXXXXX-001
—
IL
Enumeration date
06/16/2006
Last updated
07/08/2009
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