Provider Demographics
NPI:1992086979
Name:CORE, DANETTE L (PMHCNS-BC)
Entity type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:L
Last Name:CORE
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1000
Mailing Address - Country:US
Mailing Address - Phone:419-841-7701
Mailing Address - Fax:419-841-1691
Practice Address - Street 1:6605 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1000
Practice Address - Country:US
Practice Address - Phone:419-841-7701
Practice Address - Fax:419-841-1691
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN273118163W00000X
OHCOA15355-NS364SP0808X
OHRN273118-COA1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult