Provider Demographics
NPI:1962153635
Name:PANACH, DANIELLE NICOLE (CRNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:PANACH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1165
Mailing Address - Country:US
Mailing Address - Phone:724-472-7309
Mailing Address - Fax:
Practice Address - Street 1:50 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LA BELLE
Practice Address - State:PA
Practice Address - Zip Code:15450-1050
Practice Address - Country:US
Practice Address - Phone:724-364-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily