Provider Demographics
NPI:1801910500
Name:DANAHER, DANIEL CORNELIUS (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CORNELIUS
Last Name:DANAHER
Suffix:
Gender:M
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 1:4900 DEER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5303
Mailing Address - Country:US
Mailing Address - Phone:402-423-4267
Mailing Address - Fax:
Practice Address - Street 1:4201 SOUTH 14TH ST
Practice Address - Street 2:NEBR. STATE PENITENTIARY
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-479-3291
Practice Address - Fax:402-479-3325
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant