Provider Demographics
NPI:1902467038
Name:MILLER, DANIELLE R (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:R
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8214 PFEIFFER FARMS DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8288
Mailing Address - Country:US
Mailing Address - Phone:616-235-5101
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5782
Practice Address - Country:US
Practice Address - Phone:616-235-5101
Practice Address - Fax:616-949-9020
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282702363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner