Provider Demographics
NPI:1689042293
Name:DANNER, MADISON MARGARET
Entity Type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:MARGARET
Last Name:DANNER
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:PO BOX 81162
Mailing Address - Street 2:1400 GREENE ST
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29225-0001
Mailing Address - Country:US
Mailing Address - Phone:609-774-4107
Mailing Address - Fax:
Practice Address - Street 1:1400 GREENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29225-0001
Practice Address - Country:US
Practice Address - Phone:609-774-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer