Provider Demographics
NPI:1881113421
Name:SLATE, DANIELLE JOSEPHINE (RN, BSN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JOSEPHINE
Last Name:SLATE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CLINTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1364
Mailing Address - Country:US
Mailing Address - Phone:607-316-3948
Mailing Address - Fax:
Practice Address - Street 1:129 SERAFEN LN
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3645
Practice Address - Country:US
Practice Address - Phone:607-437-5294
Practice Address - Fax:607-437-5294
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY734716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse