Provider Demographics
NPI:1902281611
Name:EVERTS, DANIELLE (SET)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:EVERTS
Suffix:
Gender:F
Credentials:SET
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:VANNOSTRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SET
Mailing Address - Street 1:5871 GROVELAND STATION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9767
Mailing Address - Country:US
Mailing Address - Phone:585-658-4023
Mailing Address - Fax:585-658-4066
Practice Address - Street 1:5871 GROVELAND STATION RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9767
Practice Address - Country:US
Practice Address - Phone:585-658-4023
Practice Address - Fax:585-658-4066
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY961053151174400000X
NY880444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist