Provider Demographics
NPI:1124750286
Name:DU FRESNE, DANIELLE KATHRYN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHRYN
Last Name:DU FRESNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8365
Mailing Address - Country:US
Mailing Address - Phone:503-421-9173
Mailing Address - Fax:
Practice Address - Street 1:155 PARKWAY OFFICE CT STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7427
Practice Address - Country:US
Practice Address - Phone:919-233-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant