Basic Information
| Provider Information | |||||||||
| NPI: | 1689718264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NANCE | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STUEBER | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | NANCE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2940 E. BANNER GATEWAY DRIVE | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802563430 | ||||||||
| FaxNumber: | 4802563682 | ||||||||
| Practice Location | |||||||||
| Address1: | 2946 E. BANNER GATEWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802566444 | ||||||||
| FaxNumber: | 4802563682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD60095890 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | 8236478-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0000X | 50742 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 204R00000X | MD60095890 | WA | N | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1689718264 | 05 | WA | MEDICAID |