Provider Demographics
NPI:1568599645
Name:DANIELS, BRENDA M (CNM)
Entity Type:Individual
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First Name:BRENDA
Middle Name:M
Last Name:DANIELS
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:80 68TH ST SE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6980
Practice Address - Country:US
Practice Address - Phone:616-532-1410
Practice Address - Fax:616-532-5017
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-02-24
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Provider Licenses
StateLicense IDTaxonomies
MI4704109908367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife