Provider Demographics
NPI:1740646892
Name:FITZ, DANIELLE LYNNE (LPN)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:LYNNE
Last Name:FITZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:LYNNE
Other - Last Name:MAX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:507 OLD AGENCY DR
Mailing Address - Street 2:UNIT 137A
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-7226
Mailing Address - Country:US
Mailing Address - Phone:605-698-7606
Mailing Address - Fax:
Practice Address - Street 1:507 OLD AGENCY DR
Practice Address - Street 2:UNIT 137A
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7226
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN-68919-1164W00000X
SDP011829164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse