Provider Demographics
NPI:1790508851
Name:PHILLIPS, DANIELLE MARIE (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:DRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1000
Mailing Address - Country:US
Mailing Address - Phone:810-837-1333
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2196
Practice Address - Country:US
Practice Address - Phone:313-966-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288939363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics