Provider Demographics
NPI:1164933354
Name:ST AMOUR, DANIEL (NP-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ST AMOUR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22601 ALLEN RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2273
Mailing Address - Country:US
Mailing Address - Phone:734-752-4353
Mailing Address - Fax:734-671-9000
Practice Address - Street 1:22601 ALLEN RD STE 400
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2273
Practice Address - Country:US
Practice Address - Phone:734-752-4353
Practice Address - Fax:734-671-9000
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health