1376012070 NPI number — MS. TAMBRA RENEE DANIELS APNP, FN-BC

Table of content: MS. TAMBRA RENEE DANIELS APNP, FN-BC (NPI 1376012070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376012070 NPI number — MS. TAMBRA RENEE DANIELS APNP, FN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIELS
Provider First Name:
TAMBRA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APNP, FN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376012070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMPASS BEHAVIORAL HEALTH CLINIC
Provider Second Line Business Mailing Address:
1820 CENTER AVENUE
Provider Business Mailing Address City Name:
JANESVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-755-1475
Provider Business Mailing Address Fax Number:
608-755-1733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53546-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-755-1475
Provider Business Practice Location Address Fax Number:
608-755-1733
Provider Enumeration Date:
11/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  8930-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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