Provider Demographics
NPI:1235884362
Name:WEISHAAR, DANIELLE ELISE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELISE
Last Name:WEISHAAR
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 1:2061 MOUNT CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8350
Mailing Address - Country:US
Mailing Address - Phone:501-424-1427
Mailing Address - Fax:
Practice Address - Street 1:11900 COLONEL GLENN RD STE 2000
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2829
Practice Address - Country:US
Practice Address - Phone:501-202-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty