Healthcare Provider Details

I. General information

NPI: 1821799644
Provider Name (Legal Business Name): DANIELLE HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MORRIS AVE SE APT 4
GRAND RAPIDS MI
49503-4690
US

IV. Provider business mailing address

205 MORRIS AVE SE APT 4
GRAND RAPIDS MI
49503-4690
US

V. Phone/Fax

Practice location:
  • Phone: 517-899-5392
  • 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: