Healthcare Provider Details

I. General information

NPI: 1700375524
Provider Name (Legal Business Name): DANIELLE NICOLE FASSIEUX CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 RANDOLPH RD
CHARLOTTE NC
28211-1018
US

IV. Provider business mailing address

12714 WILLINGDON RD
HUNTERSVILLE NC
28078-5704
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-1647
  • Fax:
Mailing address:
  • Phone: 619-248-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number685804
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number328754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: