Provider Demographics
NPI:1336749027
Name:MARTIN, DANIELLE (FNTP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNTP
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OR
Mailing Address - Zip Code:97638-0211
Mailing Address - Country:US
Mailing Address - Phone:707-540-4541
Mailing Address - Fax:
Practice Address - Street 1:155 SW CENTURY DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1657
Practice Address - Country:US
Practice Address - Phone:707-540-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education