Provider Demographics
NPI:1033870985
Name:BLONSTEIN, DANIELLE MICHELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MICHELLE
Last Name:BLONSTEIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 J ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4767
Mailing Address - Country:US
Mailing Address - Phone:650-391-7545
Mailing Address - Fax:
Practice Address - Street 1:508 GIBSON DR STE 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5796
Practice Address - Country:US
Practice Address - Phone:916-773-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019613363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics