=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124471263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE BARISONE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2016
-----------------------------------------------------
Last Update Date | 09/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5070 ION DR SUITE 200
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-352-5335
-----------------------------------------------------
Fax | 775-352-5334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 E. PRATER WAY SUITE 207
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-356-4067
-----------------------------------------------------
Fax | 775-356-5590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | APRN002290
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------