Provider Demographics
NPI:1316263015
Name:CLARK, DANIELLE NICOLE (DO)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:SLIFKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:723 ENCLAVE VILLAGE PL
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7540
Mailing Address - Country:US
Mailing Address - Phone:216-570-8378
Mailing Address - Fax:
Practice Address - Street 1:440 BROWNS LN
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2044
Practice Address - Country:US
Practice Address - Phone:740-891-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics