Healthcare Provider Details

I. General information

NPI: 1790602662
Provider Name (Legal Business Name): DANIELE WILSON RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MORNINGSTAR CT
HANOVER PA
17331-9137
US

IV. Provider business mailing address

203 MORNINGSTAR CT
HANOVER PA
17331-9137
US

V. Phone/Fax

Practice location:
  • Phone: 717-521-2314
  • Fax:
Mailing address:
  • Phone: 717-521-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberDN000530
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: