Provider Demographics
NPI:1497430094
Name:CARDWELL, DANIELLE TERESA
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TERESA
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:TERESA
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11954 NE GLISAN ST # 311
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2143
Mailing Address - Country:US
Mailing Address - Phone:360-860-0015
Mailing Address - Fax:
Practice Address - Street 1:7759 SE 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7921
Practice Address - Country:US
Practice Address - Phone:503-788-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201801218CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide