Provider Demographics
NPI:1710104955
Name:EADES, DANIELLE ELSIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELSIE
Last Name:EADES
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 1:1333 POPS DR
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-9085
Mailing Address - Country:US
Mailing Address - Phone:913-306-2494
Mailing Address - Fax:
Practice Address - Street 1:2810 16TH ST NE # 200
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9600
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004590363A00000X
COPAL-2637363A00000X
NC0010-08010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant