Basic Information
| Provider Information | |||||||||
| NPI: | 1750894184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENSLEY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JACOB | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897067913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758886610 | ||||||||
| FaxNumber: | 7758884904 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 WELLS AVENUE | ||||||||
| Address2: | P.O. BOX 3520 | ||||||||
| City: | WEST WENDOVER | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898833520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756642220 | ||||||||
| FaxNumber: | 7756642965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2017 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 6010580-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA1899 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA1899 | 01 | NV | NEVADA PHYSICIAN ASSISTANT LICENSE | OTHER |