Provider Demographics
NPI:1194093708
Name:ANDERSON HERTAUS, DANIELLE MARIE
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:ANDERSON HERTAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11041 WISCONSIN AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3721
Mailing Address - Country:US
Mailing Address - Phone:763-482-2477
Mailing Address - Fax:763-424-4684
Practice Address - Street 1:11041 WISCONSIN AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3721
Practice Address - Country:US
Practice Address - Phone:763-482-2477
Practice Address - Fax:763-424-4684
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist