Provider Demographics
NPI:1902118433
Name:JOHNSTON, DANIELLE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:10865 KELLER RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9276 MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1969
Practice Address - Country:US
Practice Address - Phone:716-759-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014020-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant