Provider Demographics
NPI:1790156818
Name:SNELLEN, DANIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SNELLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1091
Mailing Address - Country:US
Mailing Address - Phone:270-200-1095
Mailing Address - Fax:833-989-0949
Practice Address - Street 1:506 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1091
Practice Address - Country:US
Practice Address - Phone:270-200-1095
Practice Address - Fax:833-989-0949
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009796OtherAPRN LICENSE
KY7100369380Medicaid