Provider Demographics
NPI:1477694552
Name:HENKEL, DANIEL A (MT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:HENKEL
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3170
Mailing Address - Country:US
Mailing Address - Phone:651-483-4321
Mailing Address - Fax:
Practice Address - Street 1:3508 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-3170
Practice Address - Country:US
Practice Address - Phone:651-483-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNONE REQUIRED247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other