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General NPI Number Information
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NPI Number | 1417619214
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Entity Type | Individual
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Provider Name | DARLA DANE NP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 710 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2379
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Country | US
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Telephone | 419-973-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 710 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2379
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Country | US
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Telephone | 616-421-9387
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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 | 0030094
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704356150
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 290478
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License Number State | AZ
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