Provider Demographics
NPI:1700403581
Name:PONTIUS, DAPHNE (APRN WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:APRN WHNP-BC
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4636
Mailing Address - Country:US
Mailing Address - Phone:800-246-5743
Mailing Address - Fax:715-675-1819
Practice Address - Street 1:621 MEMORIAL DR STE 403
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-647-1405
Practice Address - Fax:574-647-3970
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012429A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300061190Medicaid