Provider Demographics
NPI:1871067090
Name:SMITH, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SMITH
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 1:115 SUNNYSIDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:WA
Mailing Address - Zip Code:98932-9348
Mailing Address - Country:US
Mailing Address - Phone:509-865-6450
Mailing Address - Fax:509-854-1919
Practice Address - Street 1:115 SUNNYSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932-9348
Practice Address - Country:US
Practice Address - Phone:509-865-6450
Practice Address - Fax:509-854-1919
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10304628-4405208M00000X
WAAP61017572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist