Provider Demographics
NPI:1114077138
Name:KIZER, DANIELLE L (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:KIZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-788-6993
Mailing Address - Fax:360-715-6993
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:ATTN:BEHAVIORAL HEALTH SERVICES
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-788-6993
Practice Address - Fax:360-715-6996
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD000378822084P0805X
WABK63321002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0256896OtherL&I AND CRIME VICTIMS
WA1114077138Medicaid
WA8489262Medicaid
WA7049911OtherAETNA
WA5889KIOtherREGENCE
212820Medicare UPIN
WA8489262Medicaid
WAG8877331Medicare PIN