Provider Demographics
NPI:1356877708
Name:WINCHELL, DANIELLE (MAOM, LAC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WINCHELL
Suffix:
Gender:F
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:OLIVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MAOM
Mailing Address - Street 1:265 MILWAUKEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105
Mailing Address - Country:US
Mailing Address - Phone:714-328-6548
Mailing Address - Fax:
Practice Address - Street 1:265 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1839
Practice Address - Country:US
Practice Address - Phone:714-328-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI936-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist