Healthcare Provider Details

I. General information

NPI: 1760963284
Provider Name (Legal Business Name): DANIELLE WEEKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17219 TARKIO WAY
SAN ANTONIO TX
78247-5844
US

IV. Provider business mailing address

7710 W INTERSTATE 10
SAN ANTONIO TX
78230-4711
US

V. Phone/Fax

Practice location:
  • Phone: 616-402-7134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberMI000039462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: