Healthcare Provider Details

I. General information

NPI: 1568599645
Provider Name (Legal Business Name): BRENDA M DANIELS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 68TH ST SE SUITE 301
GRAND RAPIDS MI
49548-6980
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-532-1410
  • Fax: 616-532-5017
Mailing address:
  • Phone: 616-486-6790
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704109908
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: