Provider Demographics
NPI:1487701801
Name:DANALS, LAURA LEE (APRN,BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:DANALS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1072
Mailing Address - Country:US
Mailing Address - Phone:419-759-8998
Mailing Address - Fax:419-756-9733
Practice Address - Street 1:341 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1072
Practice Address - Country:US
Practice Address - Phone:419-759-8998
Practice Address - Fax:419-756-9733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS01923364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCPT01923 RXOtherCERTIFICATE TO PERSCRIBE
OHCPT01923 RXOtherCERTIFICATE TO PERSCRIBE