=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700328325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL HEALTH & WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2016
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17430 CAMPBELL RD STE 207
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-846-0448
-----------------------------------------------------
Fax | 972-502-9548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17762 PRESTON RD STE 114
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-846-0448
-----------------------------------------------------
Fax | 972-502-9548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER/OWNER
-----------------------------------------------------
Name | LAVONIA ADUBA
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 972-846-0448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | AP130091
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------