Healthcare Provider Details

I. General information

NPI: 1255642690
Provider Name (Legal Business Name): DANIELLE JOY STAGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S WELLS AVE
RENO NV
89502-2550
US

IV. Provider business mailing address

680 S ROCK BLVD
RENO NV
89502-4113
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-6300
  • Fax: 775-336-0646
Mailing address:
  • Phone: 775-329-6300
  • Fax: 775-336-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61040-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15723
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: