Provider Demographics
NPI:1962716233
Name:CREDEUR, DANNY WAYNE (FNP-C)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:WAYNE
Last Name:CREDEUR
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 W PORT ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1754
Mailing Address - Country:US
Mailing Address - Phone:409-736-2800
Mailing Address - Fax:409-736-0361
Practice Address - Street 1:5885 W PORT ARTHUR RD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1754
Practice Address - Country:US
Practice Address - Phone:409-736-2800
Practice Address - Fax:409-736-0361
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily