Provider Demographics
NPI:1164826749
Name:SMITH, DANIELLE ROSE (PA)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9799
Mailing Address - Country:US
Mailing Address - Phone:937-652-1834
Mailing Address - Fax:937-652-1619
Practice Address - Street 1:1958 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9799
Practice Address - Country:US
Practice Address - Phone:937-652-1834
Practice Address - Fax:937-652-1619
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant