Provider Demographics
NPI:1023690278
Name:WILSON, DANYALLE ALTMAN
Entity type:Individual
Prefix:
First Name:DANYALLE
Middle Name:ALTMAN
Last Name:WILSON
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 1:418 DUVALL ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2163
Mailing Address - Country:US
Mailing Address - Phone:864-508-1184
Mailing Address - Fax:
Practice Address - Street 1:200 MCDANIEL AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2527
Practice Address - Country:US
Practice Address - Phone:864-898-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC038729146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic