Basic Information
| Provider Information | |||||||||
| NPI: | 1053716233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOLTZ | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | KELLY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 COMPUTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197825273 | ||||||||
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| Practice Location | |||||||||
| Address1: | JOHNSON HEALTH CENTER | ||||||||
| Address2: | 320 FEDERAL STREET | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349475967 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2014 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 5008905 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1053716233 | 05 | CA | MEDICAID |