1689043705 NPI number — MS. DANIELLE RENEE JACOBS-WOODWARD CPHT.,RPHT

Table of content: MS. DANIELLE RENEE JACOBS-WOODWARD CPHT.,RPHT (NPI 1689043705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689043705 NPI number — MS. DANIELLE RENEE JACOBS-WOODWARD CPHT.,RPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS-WOODWARD
Provider First Name:
DANIELLE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CPHT.,RPHT
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:
1689043705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8138 E VERNOR HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48214-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-402-6657
Provider Business Mailing Address Fax Number:
586-757-7785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22835 VAN DYKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-757-6505
Provider Business Practice Location Address Fax Number:
586-757-7785
Provider Enumeration Date:
09/18/2015

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: 183700000X , with the licence number:  5303000537 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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