Provider Demographics
NPI:1932384443
Name:KING, DANIELLE MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ROCKY MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3011
Mailing Address - Country:US
Mailing Address - Phone:774-259-3474
Mailing Address - Fax:
Practice Address - Street 1:7 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5234
Practice Address - Country:US
Practice Address - Phone:845-494-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289732-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse