Provider Demographics
NPI:1164037669
Name:CASTLE, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CASTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TALLMAN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060-9722
Mailing Address - Country:US
Mailing Address - Phone:937-309-9610
Mailing Address - Fax:
Practice Address - Street 1:190 TALLMAN ST APT 4
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060-9722
Practice Address - Country:US
Practice Address - Phone:937-309-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168229Medicaid