Healthcare Provider Details

I. General information

NPI: 1770437980
Provider Name (Legal Business Name): DANIELLE EMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 RICHELIEU RD
WILMINGTON NC
28412-7934
US

IV. Provider business mailing address

32503 COUSER CANYON RD
VALLEY CENTER CA
92082-3610
US

V. Phone/Fax

Practice location:
  • Phone: 513-593-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024660
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039670
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95081894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: