Provider Demographics
NPI:1346597002
Name:JUSTICE, DANIELLE LEE (STNA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 CLIMBING FIG DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-6061
Mailing Address - Country:US
Mailing Address - Phone:614-530-4866
Mailing Address - Fax:
Practice Address - Street 1:1387 CLIMBING FIG DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-6061
Practice Address - Country:US
Practice Address - Phone:614-530-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X
OH99999999171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications