Healthcare Provider Details

I. General information

NPI: 1568652782
Provider Name (Legal Business Name): DANIELLE CAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 GARRETT WAY SUITE 1
POCATELLO ID
83201-5100
US

IV. Provider business mailing address

808 N 8TH AVE
POCATELLO ID
83201-5718
US

V. Phone/Fax

Practice location:
  • Phone: 208-236-1600
  • Fax: 208-236-6695
Mailing address:
  • Phone: 206-236-1600
  • Fax: 208-236-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: