Basic Information
| Provider Information | |||||||||
| NPI: | 1396023958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER-GARTNER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2624 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581032350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012984500 | ||||||||
| FaxNumber: | 7012984400 | ||||||||
| Practice Location | |||||||||
| Address1: | 2624 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581032350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012984500 | ||||||||
| FaxNumber: | 7012984400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2011 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802086254 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 54523 | 05 | ND | MEDICAID |