MEDICARE: MS. DANIELLE ROSE SMITH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.004143	OH

General Provider Information

NPI Number	:	1164826749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE ROSE SMITH PA

Provider Business Mailing Address
First Line	:	1958 E US HIGHWAY 36
Second Line	:
City	:	URBANA
State	:	OH
Zip	:	43078-9799
Country	:	US
Telephone Number	:	937-652-1834
Fax Number	:	937-652-1619

Provider Business Practice Location Address
First Line	:	1958 E US HIGHWAY 36
Second Line	:
City	:	URBANA
State	:	OH
Zip	:	43078-9799
Country	:	US
Telephone Number	:	937-652-1834
Fax Number	:	937-652-1619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	06/25/2019

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