Provider Demographics
NPI:1114510930
Name:AXTMAN, DANICA
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:
Last Name:AXTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 HIGHWAY 20 S
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3597
Mailing Address - Country:US
Mailing Address - Phone:017-416-0527
Mailing Address - Fax:
Practice Address - Street 1:1316 HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3597
Practice Address - Country:US
Practice Address - Phone:017-416-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant