Provider Demographics
NPI:1194003038
Name:BECKER, DANIELLE L (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:BECKER
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 1:1101 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4029
Mailing Address - Country:US
Mailing Address - Phone:814-943-9879
Mailing Address - Fax:814-943-1808
Practice Address - Street 1:1101 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4029
Practice Address - Country:US
Practice Address - Phone:814-943-9879
Practice Address - Fax:814-943-1808
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002675363A00000X
PAMA054960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033595200001Medicaid