Provider Demographics
NPI:1174288914
Name:RIDDLE, DANNY THOMAS (LPN)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:THOMAS
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7918 STATE ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:BRANT LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12815-2302
Mailing Address - Country:US
Mailing Address - Phone:518-669-5702
Mailing Address - Fax:
Practice Address - Street 1:18 HUGHES CT
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2555
Practice Address - Country:US
Practice Address - Phone:518-260-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315423164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse