Provider Demographics
NPI:1720265184
Name:DANIELSON, MEGAN MARIE (RN CNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:RN CNP
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Mailing Address - Street 1:5520 RIDGEWOOD COVE
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364
Mailing Address - Country:US
Mailing Address - Phone:612-865-5262
Mailing Address - Fax:952-472-3837
Practice Address - Street 1:3188 COUNTY ROAD 30 SE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8135
Practice Address - Country:US
Practice Address - Phone:763-972-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR159309-5363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN634472000Medicaid
MN500004305Medicare Oscar/Certification