Healthcare Provider Details

I. General information

NPI: 1235670076
Provider Name (Legal Business Name): DANIELLE STAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CROSS RDG
GREENVILLE SC
29607-4342
US

IV. Provider business mailing address

14 CROSS RDG
GREENVILLE SC
29607-4342
US

V. Phone/Fax

Practice location:
  • Phone: 315-427-3326
  • Fax:
Mailing address:
  • Phone: 315-427-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231329
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: