Provider Demographics
NPI:1396830824
Name:WARD, DANIELLE ADAIR (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ADAIR
Last Name:WARD
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 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5101
Mailing Address - Country:US
Mailing Address - Phone:503-226-6321
Mailing Address - Fax:503-227-3422
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 315
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5101
Practice Address - Country:US
Practice Address - Phone:503-226-6321
Practice Address - Fax:503-227-3422
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18526363AS0400X
ORPA157225363AS0400X
WAPA60302715363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1396830824Medicaid
CA0PA185260Medicaid
WA166133Medicare PIN
CA0PA185260Medicaid
WA8912867Medicare PIN
OR166202Medicare PIN