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General NPI Number Information
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NPI Number | 1891800132
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Entity Type | Individual
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Provider Name | DANIELLE M LOOS PA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 40 HART ST BUILDING C
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1743
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Country | US
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Telephone | 860-229-8889
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Fax | 860-229-8893
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Provider Business Mailing Address
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Address Line | 40 HART ST BUILDING C
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1743
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Country | US
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Telephone | 860-229-8889
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Fax | 860-229-8893
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001122
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License Number State | CT
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