Healthcare Provider Details

I. General information

NPI: 1114734860
Provider Name (Legal Business Name): DANIELLE NORMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

27320 PARAISO MNR
BOERNE TX
78015-5070
US

V. Phone/Fax

Practice location:
  • Phone: 254-394-1729
  • Fax:
Mailing address:
  • Phone: 254-394-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number862779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: