Individual
DANYELLE MARIE TIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 BROAD ST, JOHNSTOWN, PA 15906-2716
(814) 535-6000
(814) 248-7901
Mailing address
917 CONEMAUGH AVE, PORTAGE, PA 15946-1728
(724) 967-2130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN548194
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163WOOOOOX
—
PA
Enumeration date
09/20/2018
Last updated
09/20/2018
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