Provider Demographics
NPI:1952914657
Name:STAMPER, STAMPER DANIELLE
Entity type:Individual
Prefix:
First Name:STAMPER
Middle Name:DANIELLE
Last Name:STAMPER
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 1:1130 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4058
Mailing Address - Country:US
Mailing Address - Phone:304-696-6004
Mailing Address - Fax:
Practice Address - Street 1:STEPHEN J KOPP HALL 1538 CHARLESTON AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0001
Practice Address - Country:US
Practice Address - Phone:304-696-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0000000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program