Active NPI
Danyelle Marie Tidd, RN
- Registered Nurse
- Johnstown, PA
National Provider Identifier
1750865150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN548194
- Practice address
- 401 Broad St
Johnstown, PA 15906-2716 - Phone
- (814) 535-6000
- Fax
- (814) 248-7901
- NPI assigned
- Sep 20, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN548194 | PA | Primary |
Addresses
Primary practice location
401 Broad St
Johnstown, PA 15906-2716
Mailing address
917 Conemaugh Ave
Portage, PA 15946-1728
Phone (724) 967-2130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163WOOOOOX | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN548194 | PA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1750865150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "917 CONEMAUGH AVE",
"city": "PORTAGE",
"state": "PA",
"postal_code": "159461728",
"telephone_number": "724-967-2130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 BROAD ST",
"city": "JOHNSTOWN",
"state": "PA",
"postal_code": "159062716",
"telephone_number": "814-535-6000",
"fax_number": "814-248-7901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDD",
"first_name": "DANYELLE",
"middle_name": "MARIE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-20",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN548194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163WOOOOOX",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnstown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.