Healthcare Provider Details

I. General information

NPI: 1568072312
Provider Name (Legal Business Name): DANIELLE CVELICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W MEMORIAL DR
ANTHEM AZ
85086-4955
US

IV. Provider business mailing address

20402 N 15TH AVE
PHOENIX AZ
85027-3636
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-7410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: