Provider Demographics
NPI:1386174043
Name:RUSSELL, DANIELLE VALENTINE (SBD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:VALENTINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:SBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40673 N 3967 LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-3395
Mailing Address - Country:US
Mailing Address - Phone:580-761-9384
Mailing Address - Fax:
Practice Address - Street 1:40673 N 3967 LN
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3395
Practice Address - Country:US
Practice Address - Phone:580-761-9384
Practice Address - Fax:580-761-9384
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula