Healthcare Provider Details

I. General information

NPI: 1164399002
Provider Name (Legal Business Name): DANIELLE WIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 C CT
ASHTABULA OH
44004-4577
US

IV. Provider business mailing address

337 KEEFUS RD
CONNEAUT OH
44030-9701
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number006547
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: