Healthcare Provider Details

I. General information

NPI: 1770032823
Provider Name (Legal Business Name): DANAE RASCHELLE ERICKSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANAE RASCHELLE COOK PA

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

7425 E GARFIELD ST
SCOTTSDALE AZ
85257-4317
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-2762
  • Fax:
Mailing address:
  • Phone: 480-225-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6493
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: