=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013997212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIPA DANI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 10/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6488 WEDDINGTON-MONROE RD
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28104-7948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-316-5650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60447
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-0447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-316-3616
-----------------------------------------------------
Fax | 704-316-1199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301078535
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2009-01410
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------