Healthcare Provider Details

I. General information

NPI: 1043626559
Provider Name (Legal Business Name): DANIJELA PANDZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 WASHINTON STREET
CONNEAUTVILLE PA
16406
US

IV. Provider business mailing address

1101 MARKET ST FL 30
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-2276
  • Fax: 814-333-5781
Mailing address:
  • Phone: 215-503-3685
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: