Healthcare Provider Details

I. General information

NPI: 1548938228
Provider Name (Legal Business Name): DANIELLE NICOLE EASTERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7249 HANOVER PKWY STE D
GREENBELT MD
20770-3608
US

IV. Provider business mailing address

7249 HANOVER PKWY STE D
GREENBELT MD
20770-3608
US

V. Phone/Fax

Practice location:
  • Phone: 301-514-8952
  • Fax:
Mailing address:
  • Phone: 301-514-8952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number116689
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: