Provider Demographics
NPI:1619382561
Name:LI, DAN (NP-C)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 13TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1333
Mailing Address - Country:US
Mailing Address - Phone:229-888-3266
Mailing Address - Fax:229-888-3267
Practice Address - Street 1:810 13TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1333
Practice Address - Country:US
Practice Address - Phone:229-888-3266
Practice Address - Fax:229-888-3267
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191159363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health