Healthcare Provider Details

I. General information

NPI: 1710104955
Provider Name (Legal Business Name): DANIELLE ELSIE EADES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 16TH ST NE # 200
HICKORY NC
28601-9600
US

IV. Provider business mailing address

1333 POPS DR
CATAWBA NC
28609-9085
US

V. Phone/Fax

Practice location:
  • Phone: 704-237-4240
  • Fax:
Mailing address:
  • Phone: 913-306-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004590
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAL-2637
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: