Basic Information
Provider Information
NPI: 1295321040
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALAZAR
FirstName: DANIELLE
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: CNM, WHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 530 E THOMAS RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850123204
CountryCode: US
TelephoneNumber: 6024229000
FaxNumber: 6025565951
Practice Location
Address1: 1950 W FRYE RD BLDG B
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852246255
CountryCode: US
TelephoneNumber: 4808959555
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/16/2020
LastUpdateDate: 09/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X248035AZY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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