Healthcare Provider Details

I. General information

NPI: 1891800132
Provider Name (Legal Business Name): DANIELLE M LOOS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST BUILDING C
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

40 HART ST BUILDING C
NEW BRITAIN CT
06052-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-8889
  • Fax: 860-229-8893
Mailing address:
  • Phone: 860-229-8889
  • Fax: 860-229-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001122
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: