Provider Demographics
NPI:1568889392
Name:PAGE, DANYELL
Entity Type:Individual
Prefix:
First Name:DANYELL
Middle Name:
Last Name:PAGE
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 1:201 W HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3333
Mailing Address - Country:US
Mailing Address - Phone:843-774-5611
Mailing Address - Fax:843-841-0835
Practice Address - Street 1:201 W HAMPTON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3333
Practice Address - Country:US
Practice Address - Phone:843-774-5611
Practice Address - Fax:843-841-0835
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107274163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health