Provider Demographics
NPI:1265003396
Name:GOLTZ, DANELLE ALYCE (NP)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:ALYCE
Last Name:GOLTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 MCLEAN ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-1234
Mailing Address - Country:US
Mailing Address - Phone:402-245-8650
Mailing Address - Fax:
Practice Address - Street 1:3110 MCLEAN ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-1234
Practice Address - Country:US
Practice Address - Phone:402-245-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner