Provider Demographics
NPI:1609106079
Name:ADAMS, DANIELLE JOY
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:JOY
Last Name:ADAMS
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 1:777 HOOPES AVE APT I103
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6086
Mailing Address - Country:US
Mailing Address - Phone:541-285-6587
Mailing Address - Fax:
Practice Address - Street 1:777 HOOPES AVE
Practice Address - Street 2:APT I-103
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4972
Practice Address - Country:US
Practice Address - Phone:541-285-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist