Healthcare Provider Details

I. General information

NPI: 1558913319
Provider Name (Legal Business Name): DANIELLE JASMINE GINKEL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 MADISON AVE
ANGOLA NY
14006-9201
US

IV. Provider business mailing address

607 MADISON AVE
ANGOLA NY
14006-9201
US

V. Phone/Fax

Practice location:
  • Phone: 716-560-8220
  • Fax:
Mailing address:
  • Phone: 716-560-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number771505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: