MEDICARE: MRS. DANIELLE SARA NYQUIST

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1811705619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE SARA NYQUIST

Provider Business Mailing Address
First Line	:	3726 WOODLAWN DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-1017
Country	:	US
Telephone Number	:	802-238-0956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 WOODLAWN DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-1017
Country	:	US
Telephone Number	:	802-238-0956
Fax Number	:

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

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	01/08/2025

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