Provider Demographics
NPI:1326356361
Name:VANEVENHOVEN, DANIELLE L (APNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:VANEVENHOVEN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5282 AMY AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7233
Mailing Address - Country:US
Mailing Address - Phone:920-358-1900
Mailing Address - Fax:
Practice Address - Street 1:W5282 AMY AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7233
Practice Address - Country:US
Practice Address - Phone:920-358-1900
Practice Address - Fax:920-358-1909
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI450030695OtherMEDICARE PTAN
WI711290094OtherMEDICARE PTAN