Provider Demographics
NPI:1518322726
Name:OCAMPO, DANIELLE NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:LANGLOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13806 BONINGTON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2402
Mailing Address - Country:US
Mailing Address - Phone:248-275-6641
Mailing Address - Fax:
Practice Address - Street 1:46961 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:586-991-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5202007879OtherCOTA/L