Healthcare Provider Details

I. General information

NPI: 1235393117
Provider Name (Legal Business Name): DANIELLE JACINDA ABRAHAMSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

PO BOX 447 100 HOSPITAL AVE.
DU BOIS PA
15801-0447
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3800
  • Fax: 814-375-3886
Mailing address:
  • Phone: 814-375-3800
  • Fax: 814-375-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: