Individual
STACY DANIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1818 W FULTON ST STE 102, RAPID CITY, SD 57702-4347
(605) 787-1040
Mailing address
PO BOX 2257, CHESTERTON, IN 46304-0357
(219) 926-8320
(219) 926-3524
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0996
SD
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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