Provider Demographics
NPI:1477957926
Name:DANIELEWICZ, AGNIESZKA (RPA-C)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:DANIELEWICZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7605
Mailing Address - Country:US
Mailing Address - Phone:202-341-6650
Mailing Address - Fax:
Practice Address - Street 1:2801 GREAT NORTHERN LOOP STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1975
Practice Address - Country:US
Practice Address - Phone:406-728-6472
Practice Address - Fax:406-728-9175
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52743363A00000X
NY018039-1363A00000X
MT60414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant