Healthcare Provider Details

I. General information

NPI: 1285178830
Provider Name (Legal Business Name): DANIELLE M THOMPSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE MARCELLA LAZORKA

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BELLEFONTE AVE STE 2
LOCK HAVEN PA
17745
US

IV. Provider business mailing address

45 BELLEFONTE AVE STE 2
LOCK HAVEN PA
17745-1237
US

V. Phone/Fax

Practice location:
  • Phone: 570-858-5328
  • Fax: 570-858-5355
Mailing address:
  • Phone: 570-858-5328
  • Fax: 570-858-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP016775
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier599134F6K
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE
# 2
Identifier103308870
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: