Provider Demographics
NPI:1699773549
Name:FOX, DANIELLE BULLARD (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BULLARD
Last Name:FOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-9237
Mailing Address - Fax:360-457-1599
Practice Address - Street 1:907 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3911
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-457-1599
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY504363A00000X
UT7969893-1206363A00000X
CAPA22090363A00000X
COPA0003481363A00000X
WAPA60143632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223082OtherLABOR & INDUSTRIES
WA1016622Medicaid
WA0223082OtherLABOR & INDUSTRIES
WAP75129Medicare UPIN
WAP75129Medicare UPIN