Provider Demographics
NPI:1811439763
Name:DOUGLASS, DANIELLE SUSAN (PA-C)
Entity type:Individual
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First Name:DANIELLE
Middle Name:SUSAN
Last Name:DOUGLASS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC-845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-267-7900
Mailing Address - Fax:616-267-7901
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:SUITE 6100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-267-7900
Practice Address - Fax:616-267-7901
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2017-02-02
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical