Healthcare Provider Details

I. General information

NPI: 1508371519
Provider Name (Legal Business Name): DANIELLE WARD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD ROUTE 6
CARMEL NY
10512-2107
US

IV. Provider business mailing address

79 GLENRIDGE RD
GLENVILLE NY
12302-4523
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5202
  • Fax: 845-704-6178
Mailing address:
  • Phone: 518-952-8408
  • Fax: 518-399-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number313780
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: