Healthcare Provider Details

I. General information

NPI: 1992086979
Provider Name (Legal Business Name): DANETTE L CORE PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W CENTRAL AVE
TOLEDO OH
43617-1000
US

IV. Provider business mailing address

6605 W CENTRAL AVE
TOLEDO OH
43617-1000
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-7701
  • Fax: 419-841-1691
Mailing address:
  • Phone: 419-841-7701
  • Fax: 419-841-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCOA15355-NS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN273118-COA1
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: