Provider Demographics
NPI:1659141778
Name:DANIELS, DESTINY NICHOLE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:NICHOLE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:NICHOLE
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9156
Mailing Address - Country:US
Mailing Address - Phone:937-225-1673
Mailing Address - Fax:
Practice Address - Street 1:508 HIGHVIEW DR
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9156
Practice Address - Country:US
Practice Address - Phone:937-225-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant