Healthcare Provider Details

I. General information

NPI: 1235079203
Provider Name (Legal Business Name): DANIELLE WRUBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15157 E PURDUE AVE APT G
AURORA CO
80014-6177
US

IV. Provider business mailing address

6130 ORMOND RD
WHITE LAKE MI
48383-1032
US

V. Phone/Fax

Practice location:
  • Phone: 248-224-7482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: