Provider Demographics
NPI:1114595568
Name:FENTON, DANIELLE CHRISTINE (RN)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:CHRISTINE
Last Name:FENTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 CRIMSON CT
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2423
Mailing Address - Country:US
Mailing Address - Phone:248-961-1278
Mailing Address - Fax:
Practice Address - Street 1:556 E CIRCLE DR # 237
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7502
Practice Address - Country:US
Practice Address - Phone:517-353-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse