Provider Demographics
NPI:1003581935
Name:DANIELSON, MICALA SUE (CNP)
Entity Type:Individual
Prefix:
First Name:MICALA
Middle Name:SUE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32523 STATE HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MN
Mailing Address - Zip Code:56327-2056
Mailing Address - Country:US
Mailing Address - Phone:320-491-5786
Mailing Address - Fax:
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily