Provider Demographics
NPI:1205436375
Name:ENGWIS, DANIELLE LYNDSEY (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNDSEY
Last Name:ENGWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 JOLLY OAK RD UNIT A1040
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3554
Mailing Address - Country:US
Mailing Address - Phone:989-615-9826
Mailing Address - Fax:
Practice Address - Street 1:2025 ABBOT RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8573
Practice Address - Country:US
Practice Address - Phone:517-333-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily