Healthcare Provider Details

I. General information

NPI: 1942067004
Provider Name (Legal Business Name): DANIELLE SCHNEEWEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 E FRY BLVD STE R
SIERRA VISTA AZ
85635-2683
US

IV. Provider business mailing address

2732 PLAZA DE VIOLA
SIERRA VISTA AZ
85650-4255
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-9450
  • Fax:
Mailing address:
  • Phone: 520-481-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number296213
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: