Provider Demographics
NPI:1144409905
Name:BERTHOLD, DANIELLE BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BROOKE
Last Name:BERTHOLD
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:14650 E OLD US HIGHWAY 12
Practice Address - Street 2:SUITE 303
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-4177
Practice Address - Fax:734-475-4177
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2023-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704345235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner