Provider Demographics
NPI:1366898926
Name:WAITE, DANELLE MARIE
Entity type:Individual
Prefix:MS
First Name:DANELLE
Middle Name:MARIE
Last Name:WAITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26226 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-8597
Mailing Address - Country:US
Mailing Address - Phone:763-220-9550
Mailing Address - Fax:
Practice Address - Street 1:26226 3RD ST W
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-8597
Practice Address - Country:US
Practice Address - Phone:763-220-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker