Provider Demographics
NPI:1699486274
Name:DANFORTH, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DANFORTH
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 1:7318 PUEBLO CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9320
Mailing Address - Country:US
Mailing Address - Phone:614-205-1107
Mailing Address - Fax:
Practice Address - Street 1:7318 PUEBLO CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9320
Practice Address - Country:US
Practice Address - Phone:614-205-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty