Provider Demographics
NPI:1134696396
Name:WHITE, DANIELLE MARY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARY
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CUDWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-3157
Mailing Address - Country:US
Mailing Address - Phone:508-461-0011
Mailing Address - Fax:401-868-2385
Practice Address - Street 1:72 CUDWORTH RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-3157
Practice Address - Country:US
Practice Address - Phone:508-461-0011
Practice Address - Fax:508-949-8104
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA6999363A00000X
RIPA01118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program