Provider Demographics
NPI:1194503334
Name:DANIELS, OLIVIA FAITH (PAC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:FAITH
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1031
Mailing Address - Country:US
Mailing Address - Phone:610-730-8629
Mailing Address - Fax:
Practice Address - Street 1:2200 ST LUKES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5665
Practice Address - Country:US
Practice Address - Phone:484-503-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant