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General NPI Number Information
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NPI Number | 1528586898
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Entity Type | Individual
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Provider Name | DANIELLE ELIZABETH SAMUEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 8906 M 89
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City | RICHLAND
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State | MI
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Zip | 49083-9540
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Country | US
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Telephone | 269-286-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 8906 M 89
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City | RICHLAND
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State | MI
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Zip | 49083-9540
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Country | US
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Telephone | 269-286-7130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA8790
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012681
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License Number State | MI
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