Healthcare Provider Details

I. General information

NPI: 1952681629
Provider Name (Legal Business Name): DANNY THOMAS ST LOUIS ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

840 SILVERDALE DR.
WINDSOR ONTARIO
N9G 2V9
CA

V. Phone/Fax

Practice location:
  • Phone: 248-898-5000
  • Fax:
Mailing address:
  • Phone: 519-817-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704205382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: