Provider Demographics
NPI:1306810924
Name:BEAULIEU, DANIELLE L (NP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1179
Mailing Address - Country:US
Mailing Address - Phone:413-241-2100
Mailing Address - Fax:413-735-1986
Practice Address - Street 1:100 WASON AVE STE 120
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:413-735-1986
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6759363L00000X, 363LA2100X
MA204880363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner