Provider Demographics
NPI:1609433697
Name:SCOTT, DANIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1048
Mailing Address - Country:US
Mailing Address - Phone:618-443-4138
Mailing Address - Fax:618-443-3685
Practice Address - Street 1:1300 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1048
Practice Address - Country:US
Practice Address - Phone:618-443-4138
Practice Address - Fax:618-443-3685
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant