Most Relevant Information
Provider Data
| NPI Number: | 1003510009 |
| Provider Name: | DANIELLE ALYSSA WALES MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/27/2023 |
| Last Updated: | 06/14/2023 |
Provider Practice Location
1775 BALLARD RD
PARK RIDGE
IL
600681005
Practice Location Phone/Fax
| Phone: | 8473186020 |
| Fax: |
Provider Mailing Location
1775 BALLARD RD
PARK RIDGE
IL
600681005
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |