Individual
MS. MICHELLE MARIE DACEY-NEWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8296
(847) 984-5689
Mailing address
505 13TH ST, KENOSHA, WI 53140-4432
(262) 220-1141
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043087431
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043087431
ILLINOIS DEPARTMENT OF PROFESSIONAL REGULATIONS
IL
Enumeration date
03/08/2012
Last updated
03/08/2012
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