Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704275421 | MI |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704275421 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 4704275421 | MI |
NPI | 1073166534 |
---|---|
Provider Name | Danielle Lynn Elliott |
First Address | Macomb, MI 48044-3023 |
Second Address | Waterford, MI 48328-3310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 23/07/2019 |