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NPI Code Detail

MEDICARE: WILLIAM TANNER DANIELL

MEDICARE: WILLIAM TANNER DANIELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant11442AZ
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255173019
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM TANNER DANIELL
Provider Business Mailing Address
First Line : 18444 N 25TH AVE STE 210
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-1264
Country : US
Telephone Number : 866-974-2673
Fax Number : 866-939-2673
Provider Business Practice Location Address
First Line : 18444 N 25TH AVE STE 210
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-1264
Country : US
Telephone Number : 866-974-2673
Fax Number : 866-939-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2024
Last Update Date : 12/11/2025

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Directions to “ WILLIAM TANNER DANIELL ” Practice Location

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