Individual
KAITLYN MARIE DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 GRANT ST, GARY, IN 46402-6001
(219) 886-4000
Mailing address
9615 DONA CT APT 71, CROWN POINT, IN 46307-2139
(815) 546-2644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003460A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003460A
INDIANA LICENSE NUMBER
IN
Enumeration date
11/22/2021
Last updated
11/22/2021
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