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General NPI Number Information
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NPI Number | 1093283863
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Entity Type | Individual
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Provider Name | DANIEL EDWARD FENTON II FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 801 E ROOSEVELT AVE
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City | GRANTS
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State | NM
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Zip | 87020-2115
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Country | US
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Telephone | 505-658-1347
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Fax | 866-422-1014
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Provider Business Mailing Address
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Address Line | 824 HOUSTON AVE
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City | GRANTS
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State | NM
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Zip | 87020-3017
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Country | US
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Telephone | 505-315-1162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN-70242
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License Number State | NM
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