Individual
DANELLE DENISE DISMUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7979 WURZBACH RD, SAN ANTONIO, TX 78229-4427
(210) 450-1143
(210) 450-0407
Mailing address
7979 WURZBACH RD, SAN ANTONIO, TX 78229-4427
(210) 450-1143
(210) 450-0407
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06180
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206403203
—
TX
05
—
206403204
—
TX
01
—
206403205
CSHCN
TX
01
—
P01592862
RAILROAD
TX
Enumeration date
03/05/2009
Last updated
11/29/2018
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