Provider Demographics
NPI:1629582580
Name:MORAN, DANIELLE (MS, RD, LMNT, LD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS, RD, LMNT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 BALLPARK WAY APT 537
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11945 BALLPARK WAY APT 537
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4915
Practice Address - Country:US
Practice Address - Phone:308-235-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4261133V00000X
NE1305133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered