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General NPI Number Information
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NPI Number | 1730555889
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Entity Type | Individual
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Provider Name | DANIELLE BANDHOLZ
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Gender | Female
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 3400 W 66TH ST SUITE 290
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City | EDINA
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State | MN
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Zip | 55435-2111
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Country | US
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Telephone | 952-924-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 15620 FALCON CIR N
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City | HUGO
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State | MN
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Zip | 55038-8204
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Country | US
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Telephone | 651-707-4697
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | CNP3693
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License Number State | MN
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