Healthcare Provider Details

I. General information

NPI: 1962544189
Provider Name (Legal Business Name): NANCY DANIELSON APRN, CNS.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053-3821
US

IV. Provider business mailing address

981 HOWELL ST
SHEFFIELD LAKE OH
44054-2021
US

V. Phone/Fax

Practice location:
  • Phone: 440-204-4364
  • Fax: 440-233-9070
Mailing address:
  • Phone: 440-949-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberCOA02901NS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-187505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: