Provider Demographics
NPI:1639484645
Name:ROBERTS, DANIELLE (ARNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20148 BAGLEY DR N
Mailing Address - Street 2:#Z104
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-2758
Mailing Address - Country:US
Mailing Address - Phone:206-790-1707
Mailing Address - Fax:
Practice Address - Street 1:20148 BAGLEY DR N
Practice Address - Street 2:#Z104
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-2758
Practice Address - Country:US
Practice Address - Phone:206-790-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60146294363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health