1588179782 NPI number — DANIELLE KAYLA NILL MOTR

Table of content: DANIELLE KAYLA NILL MOTR (NPI 1588179782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588179782 NPI number — DANIELLE KAYLA NILL MOTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NILL
Provider First Name:
DANIELLE
Provider Middle Name:
KAYLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALTON
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
KAYLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588179782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 OLD BAY RD UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW DURHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03855-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-423-6478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03835-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-755-2627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2017

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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