Provider Demographics
NPI:1689332215
Name:WIDNEY, DANIELLE DEE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DEE
Last Name:WIDNEY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 LEAF ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7527
Mailing Address - Country:US
Mailing Address - Phone:909-709-2252
Mailing Address - Fax:
Practice Address - Street 1:13850 CITY CENTER DR STE 5045
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5416
Practice Address - Country:US
Practice Address - Phone:909-285-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019240363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care