Healthcare Provider Details

I. General information

NPI: 1083002646
Provider Name (Legal Business Name): DANIELLE NICOLE SOVEY NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE NICOLE KITTLE RN

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E. MICHIGAN AVE. SUITE 580
LANSING MI
48912
US

IV. Provider business mailing address

2076 WOVEN HEART DR
HOLT MI
48842-1093
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-7550
  • Fax: 517-483-8436
Mailing address:
  • Phone: 517-896-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704276054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: