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General NPI Number Information
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NPI Number | 1508493974
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Entity Type | Individual
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Provider Name | DANIELLE TAEWON UM MSN RN APRN AGPCNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 10680 MEDLOCK BRIDGE RD STE 102
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City | JOHNS CREEK
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State | GA
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Zip | 30097-8420
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Country | US
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Telephone | 770-389-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 ROSWELL RD APT 219
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-4090
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Country | US
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Telephone | 917-674-8177
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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 | 309735
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License Number State | NY
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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 | RN298325
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN298325
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 743547
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License Number State | NY
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