Provider Demographics
NPI:1306717962
Name:LANDEIS, DANIELLE KAY (RN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KAY
Last Name:LANDEIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S 12TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-3139
Mailing Address - Country:US
Mailing Address - Phone:701-426-7607
Mailing Address - Fax:
Practice Address - Street 1:2130 S 12TH ST APT 304
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-3139
Practice Address - Country:US
Practice Address - Phone:701-426-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR525883747P1801X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No163W00000XNursing Service ProvidersRegistered Nurse