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General NPI Number Information
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NPI Number | 1083782361
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Entity Type | Individual
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Provider Name | DANIELLE THREATS MSN
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 653 CHARING CROSS DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-1595
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Country | US
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Telephone | 313-399-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 653 CHARING CROSS DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-1595
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Country | US
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Telephone | 313-399-2361
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 191752
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704360173
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License Number State | MI
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