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General NPI Number Information
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NPI Number | 1518577550
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Entity Type | Individual
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Provider Name | DANIELLE VANN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 2713 CHARLES HARDY PKWY STE 223
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City | DALLAS
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State | GA
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Zip | 30157-9470
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Country | US
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Telephone | 229-800-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N WASHINGTON ST # 2S
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City | SLEEPY HOLLOW
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State | NY
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Zip | 10591-3117
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Country | US
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Telephone | 914-329-3902
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F383037
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License Number State | NY
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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 | RN305186
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License Number State | GA
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