Miss Dayna Nicole Portnoy, NP | |
1200 Central Ave, Suite 200, Wilmette, IL 60091-2654 | |
(847) 256-1705 | |
Not Available |
Full Name | Miss Dayna Nicole Portnoy |
---|---|
Gender | Female |
Speciality | Registered Nurse - General Practice |
Location | 1200 Central Ave, Wilmette, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1265476345 | NPI | - | NPPES |
P00378000 | Other | IL | MEDICARE RAILROAD |
XXXXXXXXX-001 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163WG0000X | Registered Nurse - General Practice | 041-265829 (Illinois) | Primary |
363L00000X | Nurse Practitioner | 209-006098 (Illinois) | Secondary |
Entity Name | Carelon Medical Partners, Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1124443403 PECOS PAC ID: 9931332111 Enrollment ID: O20161003002695 |
Mailing Address | Practice Location Address |
---|---|
Miss Dayna Nicole Portnoy, NP 380 Ridge Ave, 14-2, Evanston, IL 60202-3357 Ph: (847) 905-0654 | Miss Dayna Nicole Portnoy, NP 1200 Central Ave, Suite 200, Wilmette, IL 60091-2654 Ph: (847) 256-1705 |
Miyeita Giselle Magee, NP Registered Nurse Medicare: Medicare Enrolled Practice Location: 3232 Lake Ave Ste 330, Wilmette, IL 60091 Phone: 224-266-9420 | |
Mrs. Faith Mitchel Fairclough, RN BSN IBCLC Registered Nurse Medicare: Not Enrolled in Medicare Practice Location: 2019 Thornwood Ave, Wilmette, IL 60091 Phone: 847-867-3218 |