Provider Demographics
NPI:1285863605
Name:WITHERSPOON, DANIELLE MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MONIQUE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MONIQUE
Other - Last Name:BROMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2261 ESCHTRUTH ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1319
Mailing Address - Country:US
Mailing Address - Phone:440-714-8146
Mailing Address - Fax:
Practice Address - Street 1:2261 ESCHTRUTH ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1319
Practice Address - Country:US
Practice Address - Phone:440-714-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH349670163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse