Healthcare Provider Details

I. General information

NPI: 1962120972
Provider Name (Legal Business Name): DANIEL TOWERS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S 11TH ST
PHOENIX AZ
85034-4537
US

IV. Provider business mailing address

1350 S 11TH ST
PHOENIX AZ
85034-4537
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-3887
  • Fax:
Mailing address:
  • Phone: 602-257-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number246872
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: