Provider Demographics
NPI:1548620594
Name:HARDAWAY, DANIELLE BROOKS
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:BROOKS
Last Name:HARDAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13308 RAVENLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5576
Mailing Address - Country:US
Mailing Address - Phone:832-491-3081
Mailing Address - Fax:
Practice Address - Street 1:13308 RAVENLAKE DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5576
Practice Address - Country:US
Practice Address - Phone:832-491-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program