Healthcare Provider Details

I. General information

NPI: 1972209674
Provider Name (Legal Business Name): MRS. DANIELLE KAYLENE CANNAFAX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DAHLBERG DR
LINCOLN NE
68512-9216
US

IV. Provider business mailing address

1400 DAHLBERG DR
LINCOLN NE
68512-9216
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-8169
  • Fax:
Mailing address:
  • Phone: 402-423-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: