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General NPI Number Information
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NPI Number | 1013100593
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Entity Type | Individual
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Provider Name | DANIELLE LEA BLACK C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 4961 ROBERTS RD
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City | HILLIARD
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State | OH
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Zip | 43026-8129
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Country | US
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Telephone | 401-770-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 620 S CLEVELAND AVE
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City | WESTERVILLE
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State | OH
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Zip | 43081-8970
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Country | US
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Telephone | 401-770-3433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R-161420-4
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA 13327 NP
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License Number State | OH
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