Basic Information
| Provider Information | |||||||||
| NPI: | 1538791926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANCASTER | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250437046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250437046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045877301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2487 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.