Provider Demographics
NPI:1669033767
Name:ACTON, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ACTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8268 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9613
Mailing Address - Country:US
Mailing Address - Phone:616-302-2567
Mailing Address - Fax:
Practice Address - Street 1:8268 E 124TH ST
Practice Address - Street 2:
Practice Address - City:SAND LAKE
Practice Address - State:MI
Practice Address - Zip Code:49343-9613
Practice Address - Country:US
Practice Address - Phone:616-302-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician