Provider Demographics
NPI:1205390176
Name:NORDQUIST, DANIEL PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:NORDQUIST
Suffix:
Gender:M
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 1:5 INDUSTRIAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3465
Mailing Address - Country:US
Mailing Address - Phone:508-539-2444
Mailing Address - Fax:
Practice Address - Street 1:5 INDUSTRIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3465
Practice Address - Country:US
Practice Address - Phone:508-539-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant