Provider Demographics
NPI:1184057812
Name:OAKES, DANIELLE PRUZANIEC (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:PRUZANIEC
Last Name:OAKES
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 1:247 S BURNETT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2639
Mailing Address - Country:US
Mailing Address - Phone:937-328-8850
Mailing Address - Fax:937-328-8860
Practice Address - Street 1:247 S BURNETT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2639
Practice Address - Country:US
Practice Address - Phone:937-328-8850
Practice Address - Fax:937-328-8860
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC0534334Medicare PIN