Provider Demographics
NPI:1578226809
Name:KING, DANIELLE ALYSE (PA STUDENT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ALYSE
Last Name:KING
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 FELL ST APT 330
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3589
Mailing Address - Country:US
Mailing Address - Phone:443-752-6979
Mailing Address - Fax:
Practice Address - Street 1:951 FELL ST APT 330
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3589
Practice Address - Country:US
Practice Address - Phone:443-752-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant