Healthcare Provider Details

I. General information

NPI: 1629168158
Provider Name (Legal Business Name): DANIELLE YVONNE MACLAURIN APRN,BC, ANP, GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-8293
  • Fax:
Mailing address:
  • Phone: 612-863-6590
  • Fax: 612-863-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 135493-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: