Provider Demographics
NPI:1508371949
Name:CARDER, DANIELLE N
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:N
Last Name:CARDER
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 1:24634 ROAD C
Mailing Address - Street 2:
Mailing Address - City:CONTINENTAL
Mailing Address - State:OH
Mailing Address - Zip Code:45831-9423
Mailing Address - Country:US
Mailing Address - Phone:419-438-2395
Mailing Address - Fax:
Practice Address - Street 1:22897 US-20 ALT
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:419-445-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.150881OtherLICENSE