Provider Demographics
NPI:1669745469
Name:ADDLEMAN, DANIELLE KATHRYN (PA)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:KATHRYN
Last Name:ADDLEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:KATHRYN
Other - Last Name:GIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2450 SW PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4302
Mailing Address - Country:US
Mailing Address - Phone:541-276-1700
Mailing Address - Fax:541-276-6327
Practice Address - Street 1:2450 SW PERKINS AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4302
Practice Address - Country:US
Practice Address - Phone:541-276-1700
Practice Address - Fax:541-276-6327
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPA164124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500666136Medicaid