Healthcare Provider Details

I. General information

NPI: 1720998040
Provider Name (Legal Business Name): DANNELLE LOUDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20807 W INDIAN SCHOOL RD UNIT 402
BUCKEYE AZ
85396-0022
US

IV. Provider business mailing address

6622 N 91ST AVE STE 100
GLENDALE AZ
85305-2512
US

V. Phone/Fax

Practice location:
  • Phone: 970-819-5388
  • Fax:
Mailing address:
  • Phone: 623-552-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number310304
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: