Healthcare Provider Details

I. General information

NPI: 1891467510
Provider Name (Legal Business Name): TRICIA DANIELLE DANIEL RN, CCM, WWCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 116TH AVE NE UNIT R3
BOTHELL WA
98011-4169
US

IV. Provider business mailing address

PO BOX 244
BOTHELL WA
98041-0244
US

V. Phone/Fax

Practice location:
  • Phone: 206-280-8963
  • Fax: 206-420-5591
Mailing address:
  • Phone: 206-280-8963
  • Fax: 206-420-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00137293
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: