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General NPI Number Information
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NPI Number | 1508680398
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE CLARK FNP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 15631 N ORACLE RD STE 165
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City | CATALINA
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State | AZ
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Zip | 85739-8691
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Country | US
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Telephone | 520-780-0304
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5296
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City | ORACLE
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State | AZ
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Zip | 85623-5296
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Country | US
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Telephone | 520-490-8557
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 316125
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License Number State | AZ
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