Provider Demographics
NPI:1134650179
Name:MCROBERTS, DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MCROBERTS
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 1:705 S BROWN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-3113
Mailing Address - Country:US
Mailing Address - Phone:937-890-5400
Mailing Address - Fax:
Practice Address - Street 1:705 S BROWN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-3113
Practice Address - Country:US
Practice Address - Phone:937-890-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH446585163WP0808X, 163WA0400X
OH134761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse