Provider Demographics
NPI:1043450463
Name:DICKMAN, DANIELLE A (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:A
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 HARNEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-0001
Mailing Address - Country:US
Mailing Address - Phone:307-745-8991
Mailing Address - Fax:
Practice Address - Street 1:2710 HARNEY ST STE 100
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-0001
Practice Address - Country:US
Practice Address - Phone:307-745-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant