Basic Information
| Provider Information | |||||||||
| NPI: | 1316543184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALLMARK | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 N LOCUST AVE | ||||||||
| Address2: | STE B | ||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384643516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317629797 | ||||||||
| FaxNumber: | 9317629798 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 N LOCUST AVE | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384643516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317629797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2020 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000028552 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.