Basic Information
| Provider Information | |||||||||
| NPI: | 1255095501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINEMAN | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | MONIQUE | ||||||||
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| Credential: | CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599012357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808885684 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2825 CAPITOL AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168870000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2021 | ||||||||
| LastUpdateDate: | 10/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0222X | 00000000000 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care | 163W00000X | 95259439 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.