Healthcare Provider Details

I. General information

NPI: 1215563093
Provider Name (Legal Business Name): DANIELLE MARIE PROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E TUOLUMNE RD
TURLOCK CA
95382-1543
US

IV. Provider business mailing address

4414 WHITE ROCK AVE
DENAIR CA
95316-9357
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-4101
  • Fax:
Mailing address:
  • Phone: 209-606-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: