Provider Demographics
NPI:1164178802
Name:HIEMSTRA, DANIELLE JEAN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:HIEMSTRA
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 1:1634 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-4118
Mailing Address - Country:US
Mailing Address - Phone:734-395-6305
Mailing Address - Fax:
Practice Address - Street 1:2482 EAGLES CIR UNIT 4
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1572
Practice Address - Country:US
Practice Address - Phone:734-829-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care