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General NPI Number Information
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NPI Number | 1750073847
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Entity Type | Individual
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Provider Name | DANIELLE NELSON
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Gender | Female
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 3543 HIGHWAY 81 # 201
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 478-957-7487
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Fax |
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Provider Business Mailing Address
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Address Line | 930 NEW HOPE RD STE 11-520
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6407
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Country | US
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Telephone | 478-957-7487
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN399354
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License Number State | GA
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