Provider Demographics
NPI:1225121098
Name:LECLAIR, DANIELLE LUISE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LUISE
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LECLAIR
Other - Last Name:SENATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3213 CORPORATE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2247
Mailing Address - Country:US
Mailing Address - Phone:617-256-5546
Mailing Address - Fax:870-408-4869
Practice Address - Street 1:3213 CORPORATE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2247
Practice Address - Country:US
Practice Address - Phone:410-870-8225
Practice Address - Fax:870-408-4869
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173012363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD151231ZDK7Medicare PIN