Provider Demographics
NPI:1457991168
Name:ANDERSON, DANIELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TAYLOR ST STE A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2406
Mailing Address - Country:US
Mailing Address - Phone:256-574-1050
Mailing Address - Fax:256-574-1045
Practice Address - Street 1:406 TAYLOR ST STE A
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2406
Practice Address - Country:US
Practice Address - Phone:256-574-1050
Practice Address - Fax:256-574-1045
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF01200439363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily