Provider Demographics
NPI:1508493974
Name:UM, DANIELLE TAEWON (MSN RN APRN AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TAEWON
Last Name:UM
Suffix:
Gender:F
Credentials:MSN RN APRN AGPCNP-C
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Mailing Address - Street 1:6050 ROSWELL RD APT 219
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4090
Mailing Address - Country:US
Mailing Address - Phone:917-674-8177
Mailing Address - Fax:
Practice Address - Street 1:10680 MEDLOCK BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8420
Practice Address - Country:US
Practice Address - Phone:770-389-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN298325163W00000X, 363L00000X
NY743547163W00000X
NY309735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse