Healthcare Provider Details

I. General information

NPI: 1649576703
Provider Name (Legal Business Name): DANIELLE MCKENZIE DRAKE APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MCKENZIE COMMERFORD

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W 143RD ST STE 200
SAVAGE MN
55378-2890
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1010
  • Fax: 952-428-1005
Mailing address:
  • Phone: 612-725-2000
  • Fax: 320-229-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4781
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: