Provider Demographics
NPI:1699881714
Name:DANIELSEN, SUSAN (MT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DANIELSEN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0828
Mailing Address - Country:US
Mailing Address - Phone:865-675-2527
Mailing Address - Fax:865-675-0998
Practice Address - Street 1:225 N HOBBS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-0828
Practice Address - Country:US
Practice Address - Phone:865-675-2527
Practice Address - Fax:865-675-0998
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18975246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN18975OtherMEDICAL TECHNOLOGIST