Provider Demographics
NPI:1821399361
Name:OTIENO, DANIEL NYARIARO
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:NYARIARO
Last Name:OTIENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-8528
Mailing Address - Country:US
Mailing Address - Phone:612-876-6714
Mailing Address - Fax:
Practice Address - Street 1:13420 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-8528
Practice Address - Country:US
Practice Address - Phone:612-876-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver