Provider Demographics
NPI:1912242504
Name:DUES, DANIELLE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:DUES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W VOTAW ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1302
Mailing Address - Country:US
Mailing Address - Phone:260-726-8822
Mailing Address - Fax:260-726-7857
Practice Address - Street 1:428 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1302
Practice Address - Country:US
Practice Address - Phone:260-726-8822
Practice Address - Fax:260-726-7857
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.370480163W00000X
IN71006918A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse