Healthcare Provider Details

I. General information

NPI: 1851962740
Provider Name (Legal Business Name): DANIELLA CHRISTINE GANAWAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 HOLLY ST
NEW LLANO LA
71461-4526
US

IV. Provider business mailing address

794 HOLLY ST
NEW LLANO LA
71461-4526
US

V. Phone/Fax

Practice location:
  • Phone: 337-424-9295
  • Fax:
Mailing address:
  • Phone: 337-424-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220695
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: