Provider Demographics
NPI:1396413225
Name:DUCHARME, DANIELLE MAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MAE
Last Name:DUCHARME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:MAE
Other - Last Name:ANDRUSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8836 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2657
Mailing Address - Country:US
Mailing Address - Phone:952-237-1796
Mailing Address - Fax:
Practice Address - Street 1:8836 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2657
Practice Address - Country:US
Practice Address - Phone:952-237-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14671363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical