Provider Demographics
NPI:1356806038
Name:DANFORD, CATHERINE ANN (PA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:DANFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1040 MARLIN LAKES CIR APT 1634
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6903
Mailing Address - Country:US
Mailing Address - Phone:614-915-2473
Mailing Address - Fax:
Practice Address - Street 1:10826 MALLARD CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7782
Practice Address - Country:US
Practice Address - Phone:704-774-3044
Practice Address - Fax:704-774-3045
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty