Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP11532 | AZ |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP11532 | AZ |
NPI | 1063991388 |
---|---|
Provider Name | Danielle Leora Colin |
First Address | Phoenix, AZ 85020-2466 |
Second Address | Phoenix, AZ 85020-2825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 08/08/2018 |