Provider Demographics
NPI:1437634151
Name:NIX, DANIELLE BRIANA-HANSEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:BRIANA-HANSEN
Last Name:NIX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:DANIELLA
Other - Middle Name:BRIANA
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1222 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-231-9879
Mailing Address - Fax:503-233-4732
Practice Address - Street 1:1222 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-231-9879
Practice Address - Fax:503-233-4732
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist