Provider Demographics
NPI:1255730479
Name:PREUSS, DANIELLE RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:PREUSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 S BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1857
Mailing Address - Country:US
Mailing Address - Phone:618-443-6228
Mailing Address - Fax:
Practice Address - Street 1:207 S BURNS AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1857
Practice Address - Country:US
Practice Address - Phone:618-443-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
085.006075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant