MEDICARE: MRS. MARY HELEN DANIELSON LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	L0384988	MN

General Provider Information

NPI Number	:	1114923539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY HELEN DANIELSON LPN

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-0460
Country	:	US
Telephone Number	:	320-239-3939
Fax Number	:	320-239-2802

Provider Business Practice Location Address
First Line	:	501 POLER ST
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-0460
Country	:	US
Telephone Number	:	320-239-3939
Fax Number	:	320-239-2802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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