Basic Information
| Provider Information | |||||||||
| NPI: | 1235757220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANNEKER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | FORREST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 PLANTATION RIDGE DR STE 190 | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 PLANTATION RIDGE DR STE 190 | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | NC | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.