Healthcare Provider Details

I. General information

NPI: 1326577578
Provider Name (Legal Business Name): DANIEL EDUARDO BEJARANO PUENTES CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL E BEJARANO RN

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MICHIGAN ST
SIDNEY OH
45365-2685
US

IV. Provider business mailing address

3712 RUNYON AVE
TROTWOOD OH
45416-1341
US

V. Phone/Fax

Practice location:
  • Phone: 937-498-5334
  • Fax: 937-494-5914
Mailing address:
  • Phone: 937-278-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020979
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.020979
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: