Individual
DANIELLE M VANDEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(414) 525-2400
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 525-2400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014695
MN
363A00000X
Physician Assistant
10958
MN
363A00000X
Physician Assistant
1570
MN
363A00000X
Physician Assistant
Primary
3298
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038810
—
WI
01
—
PO1053637
MEDICARE RAILROAD
MN
Enumeration date
05/11/2011
Last updated
11/07/2023
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