Provider Demographics
NPI:1164997235
Name:BREMER, DANIELLE CLARICE (CNM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CLARICE
Last Name:BREMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2823
Mailing Address - Country:US
Mailing Address - Phone:989-667-3377
Mailing Address - Fax:989-667-9991
Practice Address - Street 1:3175 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-667-3377
Practice Address - Fax:989-667-9991
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310782363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily