Provider Demographics
NPI:1316437544
Name:DANIELS, PAM (MA, DE)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA, DE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14485 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2368
Mailing Address - Country:US
Mailing Address - Phone:231-592-0792
Mailing Address - Fax:
Practice Address - Street 1:14485 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2368
Practice Address - Country:US
Practice Address - Phone:231-592-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator