Provider Demographics
NPI:1598866915
Name:DANIELS, ANNETTE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MICHELLE
Last Name:DANIELS
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 1:911 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-4257
Mailing Address - Country:US
Mailing Address - Phone:620-326-8171
Mailing Address - Fax:620-326-2371
Practice Address - Street 1:1323 N A ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4350
Practice Address - Country:US
Practice Address - Phone:620-326-8171
Practice Address - Fax:620-326-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS000863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant