Provider Demographics
NPI:1649361023
Name:DANIELSON, DEBORAH JOHNSON (RNEDD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JOHNSON
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:RNEDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7183 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50327-9159
Mailing Address - Country:US
Mailing Address - Phone:515-699-5807
Mailing Address - Fax:
Practice Address - Street 1:7183 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50327-9159
Practice Address - Country:US
Practice Address - Phone:515-699-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA056191163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse