Provider Demographics
NPI:1306962121
Name:KRAESSIG, DANIELLE (CNM)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KRAESSIG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DE SAINT VICTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:6201 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1108
Mailing Address - Country:US
Mailing Address - Phone:708-386-0845
Mailing Address - Fax:708-386-8472
Practice Address - Street 1:6201 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1108
Practice Address - Country:US
Practice Address - Phone:708-386-0845
Practice Address - Fax:708-386-8472
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003008367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-003008Medicaid