Provider Demographics
NPI:1285178830
Name:THOMPSON, DANIELLE M (CRNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARCELLA
Other - Last Name:LAZORKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 BELLEFONTE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1237
Mailing Address - Country:US
Mailing Address - Phone:570-858-5328
Mailing Address - Fax:570-858-5355
Practice Address - Street 1:45 BELLEFONTE AVE STE 2
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745
Practice Address - Country:US
Practice Address - Phone:570-858-5328
Practice Address - Fax:570-858-5355
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA599134F6KOtherMEDICARE
PA103308870Medicaid