Basic Information
| Provider Information | |||||||||
| NPI: | 1124579792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FESTA | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 ROUTE 113 | ||||||||
| Address2: | |||||||||
| City: | SOUDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189641000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157233280 | ||||||||
| FaxNumber: | 2157235503 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 EATON AVE STE F | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180181862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2016 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP016669 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.