Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R-161420-4 | MN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA 13327 NP | OH |
NPI | 1013100593 |
---|---|
Provider Name | Danielle Lea Black |
First Address | Westerville, OH 43081-8970 |
Second Address | Hilliard, OH 43026-8129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 15/02/2019 |