Provider Demographics
NPI:1952066342
Name:DANKLE, CHANNEN MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:CHANNEN
Middle Name:MARIE
Last Name:DANKLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHANNEN
Other - Middle Name:MARIE
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1554 THATCHER XING
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7877
Mailing Address - Country:US
Mailing Address - Phone:410-382-6620
Mailing Address - Fax:
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDANK-KW1CG363LF0000X
NC5015352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily