Provider Demographics
NPI:1710542956
Name:SMITH, DANIELLE
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:ANTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELORS
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-6631
Mailing Address - Country:US
Mailing Address - Phone:918-847-3527
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-6631
Practice Address - Country:US
Practice Address - Phone:918-847-3527
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator