Provider Demographics
NPI:1679103659
Name:RAMBO, DANIEL JEFFERY
Entity type:Individual
Prefix:MRS
First Name:DANIEL
Middle Name:JEFFERY
Last Name:RAMBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 LORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1529
Mailing Address - Country:US
Mailing Address - Phone:810-650-1341
Mailing Address - Fax:
Practice Address - Street 1:2876 HENRY ST UNIT 2
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7365
Practice Address - Country:US
Practice Address - Phone:810-937-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider