Provider Demographics
NPI:1083018758
Name:VAN WART, DANIELA CHRIST (LAC, MA)
Entity Type:Individual
Prefix:MS
First Name:DANIELA
Middle Name:CHRIST
Last Name:VAN WART
Suffix:
Gender:F
Credentials:LAC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 PASEO SAN LUIS
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4630
Mailing Address - Country:US
Mailing Address - Phone:520-803-0071
Mailing Address - Fax:
Practice Address - Street 1:1827 PASEO SAN LUIS
Practice Address - Street 2:SUITE B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4630
Practice Address - Country:US
Practice Address - Phone:520-803-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist