Provider Demographics
NPI:1962755728
Name:WHITE, DANIELLE (CPI, CMAC, CPT, EKGC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPI, CMAC, CPT, EKGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N STATE HIGHWAY 360 STE 602
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1027
Mailing Address - Country:US
Mailing Address - Phone:214-865-7089
Mailing Address - Fax:
Practice Address - Street 1:2100 N STATE HIGHWAY 360 STE 602
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1027
Practice Address - Country:US
Practice Address - Phone:214-865-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X, 172V00000X
TX17-3128230202K00000X
174H00000X, 246RM2200X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy