=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316759392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE BRANDENBURG CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10208 CERNY ST STE 100
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27617-7885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-781-7490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 RAWLS MEADOW LN
-----------------------------------------------------
City | FUQUAY VARINA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27526-3780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-924-8261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 5021553
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------