Healthcare Provider Details

I. General information

NPI: 1447437942
Provider Name (Legal Business Name): DANIEL JOSEPH DEUSTERMAN F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE SUITE 101
PHOENIX AZ
85027-4003
US

IV. Provider business mailing address

2500 W UTOPIA RD SUITE 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-8512
  • Fax: 602-942-1075
Mailing address:
  • Phone: 623-434-6200
  • Fax: 623-434-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2956
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberAP2956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: