Provider Demographics
NPI:1679233746
Name:BRANDL, DANIELLE K (TATTOOIST)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:K
Last Name:BRANDL
Suffix:
Gender:F
Credentials:TATTOOIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53114-1446
Mailing Address - Country:US
Mailing Address - Phone:608-931-1673
Mailing Address - Fax:
Practice Address - Street 1:222 STATE HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-3053
Practice Address - Country:US
Practice Address - Phone:608-931-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4351246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty