Healthcare Provider Details

I. General information

NPI: 1659670560
Provider Name (Legal Business Name): DANIELLE LEROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N3015 HICKORY DR
BROWNSVILLE WI
53006
US

IV. Provider business mailing address

1629 MICHIGAN ST
OSHKOSH WI
54902-6862
US

V. Phone/Fax

Practice location:
  • Phone: 920-933-4344
  • Fax: 866-670-0316
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number4614-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: