Basic Information
Provider Information
NPI: 1033558655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LALIBERTE
FirstName: DANIELLE
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1915 LENDEW ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274087033
CountryCode: US
TelephoneNumber: 3362753325
FaxNumber: 3362755346
Practice Location
Address1: 1915 LENDEW ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274087033
CountryCode: US
TelephoneNumber: 3362753325
FaxNumber: 3362755346
Other Information
ProviderEnumerationDate: 06/17/2013
LastUpdateDate: 06/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X001004294NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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