Provider Demographics
NPI:1952999815
Name:MACIAS, DANIELLE RAE (DNPA)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:RAE
Last Name:MACIAS
Suffix:
Gender:F
Credentials:DNPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 S BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6316
Mailing Address - Country:US
Mailing Address - Phone:575-491-4968
Mailing Address - Fax:
Practice Address - Street 1:3029 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3465
Practice Address - Country:US
Practice Address - Phone:918-701-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200683367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered