Provider Demographics
NPI:1013944578
Name:DANICH, MARY MARGARET (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:DANICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 395
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-3111
Mailing Address - Fax:612-626-0665
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:606 24TH AVENUE SOUTH, SUITE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-627-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 081679-9363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN74-00008OtherMEDICA CHOICE
MN15G20DAOtherARAZ
MN74-25181OtherMEDICA PRIMARY
MS123322OtherUCARE
MN1019358OtherPREFERRED ONE
MN847095OtherARAZ
MN727018600Medicaid
MN500001110Medicare ID - Type UnspecifiedMN MEDICARE