Healthcare Provider Details

I. General information

NPI: 1497231849
Provider Name (Legal Business Name): DANIELLE VANARK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S MAIN STREET
BIRCHWOOD WI
54817
US

IV. Provider business mailing address

15954 RIVERS EDGE DR STE 304
HAYWARD WI
54843-7894
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-2541
  • Fax:
Mailing address:
  • Phone: 715-634-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: