Healthcare Provider Details

I. General information

NPI: 1689080731
Provider Name (Legal Business Name): DANIELLE LEE OAS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE LEE KAST DNP

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD SUITE 192
GILBERT AZ
85233-5102
US

IV. Provider business mailing address

890 W ELLIOT RD SUITE 192
GILBERT AZ
85233-5102
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2787
  • Fax: 480-545-1434
Mailing address:
  • Phone: 480-545-2787
  • Fax: 480-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: