Provider Demographics
NPI:1265981088
Name:SCALA, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SCALA
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 1:12644 EUDORA ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3048
Mailing Address - Country:US
Mailing Address - Phone:541-227-4750
Mailing Address - Fax:
Practice Address - Street 1:502 LAKE LOUISE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3152
Practice Address - Country:US
Practice Address - Phone:541-227-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2023-09-13
Deactivation Date:2023-08-22
Deactivation Code:
Reactivation Date:2023-09-01
Provider Licenses
StateLicense IDTaxonomies
WA60387285163W00000X
WA61461369363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse