Healthcare Provider Details

I. General information

NPI: 1144191214
Provider Name (Legal Business Name): DANIELLE POE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 OWEN DR STE 107
FAYETTEVILLE NC
28304-3880
US

IV. Provider business mailing address

2657 ADDISON MEADOWS LN
INDIANAPOLIS IN
46203-6725
US

V. Phone/Fax

Practice location:
  • Phone: 910-307-7330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5024974
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number28285027A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: