Healthcare Provider Details

I. General information

NPI: 1427980770
Provider Name (Legal Business Name): DANIELLE ROSE VANDEVELDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GREEN BAY RD APT 6
DENMARK WI
54208-8503
US

IV. Provider business mailing address

211 GREEN BAY RD
DENMARK WI
54208-9762
US

V. Phone/Fax

Practice location:
  • Phone: 920-367-3465
  • Fax:
Mailing address:
  • Phone: 920-367-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17225-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: