Individual
MRS. DANIELLE WALLINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
25410 PARK AVE, APARTMENT E, NIOBRARA, NE 68760-7044
(402) 857-3398
(402) 857-3315
Mailing address
25410 PARK AVE, APARTMENT E, NIOBRARA, NE 68760-7044
(402) 857-3398
(402) 857-3315
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
908
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025001900
—
NE
01
—
30387
BLUE SHIELD
NE
01
—
5300850
MEDICAID
SD
05
—
5300850
—
SD
01
—
9210187
DAKOTACARE
NE
01
—
9955
MIDLANDS CHOICE
NE
Enumeration date
10/02/2006
Last updated
07/08/2007
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