Healthcare Provider Details

I. General information

NPI: 1013944578
Provider Name (Legal Business Name): MARY MARGARET DANICH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MINNESOTA PHYSICIANS 606 24TH AVENUE SOUTH, SUITE 500
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

UNIVERSITY OF MINNESOTA PHYSICIANS 420 DELAWARE STREET SE, MMC 395
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-627-4564
  • Fax:
Mailing address:
  • Phone: 612-626-3111
  • Fax: 612-626-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 081679-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR 081679-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: