Provider Demographics
NPI:1548690795
Name:BEAN, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BEAN
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 1:110 UTICA ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3652
Mailing Address - Country:US
Mailing Address - Phone:607-379-9353
Mailing Address - Fax:
Practice Address - Street 1:110 UTICA ST
Practice Address - Street 2:APT 2
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3652
Practice Address - Country:US
Practice Address - Phone:607-379-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22671505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse