MEDICARE: DANIELLE BROCCOLI RN

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	163WX0002X	High-Risk Obstetric Registered Nurse	962107	TX

General Provider Information

NPI Number	:	1437786910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE BROCCOLI RN

Provider Business Mailing Address
First Line	:	483 CLEAR CREEK LN
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-3310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7709
Country	:	US
Telephone Number	:	908-370-8735
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	03/25/2020

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