Provider Demographics
NPI:1790500163
Name:ADDISON, DANIELLE CATHERINE (RN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CATHERINE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CATHERINE
Other - Last Name:BLAESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1516 QUINCE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4264
Mailing Address - Country:US
Mailing Address - Phone:218-820-6833
Mailing Address - Fax:
Practice Address - Street 1:606 NW 5TH ST # B
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2904
Practice Address - Country:US
Practice Address - Phone:218-848-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2499412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse