MEDICARE: DANIELLE LUISE LECLAIR CRNP

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	363LA2200X	Adult Health Nurse Practitioner	R173012	MD

General Provider Information

NPI Number	:	1225121098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LUISE LECLAIR CRNP

Provider Business Mailing Address
First Line	:	3213 CORPORATE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2247
Country	:	US
Telephone Number	:	617-256-5546
Fax Number	:	870-408-4869

Provider Business Practice Location Address
First Line	:	3213 CORPORATE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2247
Country	:	US
Telephone Number	:	410-870-8225
Fax Number	:	870-408-4869

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/28/2024

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