Provider Demographics
NPI:1043573363
Name:NICHOLSON, DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:CHCA CHOP CAMPUS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3550 MARKET ST FL 4
Practice Address - Street 2:CHCA CHOP CAMPUS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3368
Practice Address - Country:US
Practice Address - Phone:215-590-2178
Practice Address - Fax:215-590-4619
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics