Healthcare Provider Details

I. General information

NPI: 1124914916
Provider Name (Legal Business Name): DANIELLE RIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W HOWE RD
DEWITT MI
48820-7815
US

IV. Provider business mailing address

22601 BRAESIDE CIR APT 302
FARMINGTON HILLS MI
48335-3953
US

V. Phone/Fax

Practice location:
  • Phone: 517-881-6834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: