Provider Demographics
NPI:1265447940
Name:DEMETER, DANIELLE M (CNM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:DEMETER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 STATION LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5425
Mailing Address - Country:US
Mailing Address - Phone:435-640-6848
Mailing Address - Fax:435-214-7246
Practice Address - Street 1:1526 UTE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7654
Practice Address - Country:US
Practice Address - Phone:435-615-8500
Practice Address - Fax:435-214-7246
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5167458-4402176B00000X
UT5167458-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ45306Medicare UPIN