Healthcare Provider Details

I. General information

NPI: 1669354015
Provider Name (Legal Business Name): DANIELLE SUE THOMAS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

4323 GLEN ESTE WITHAMSVILLE RD UNIT 105
CINCINNATI OH
45245-2071
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax: 937-294-9010
Mailing address:
  • Phone: 513-570-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0039947
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: