Basic Information
| Provider Information | |||||||||
| NPI: | 1659942340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUART | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 10TH AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | MARLINTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249541345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046464196 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 DUNCAN RD | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249249037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047997400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2021 | ||||||||
| LastUpdateDate: | 07/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2941 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.