Provider Demographics
NPI:1164709788
Name:STURM, DANIELLE C (PA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:STURM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:LORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2777 E CAMELBACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4352
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-224-9119
Practice Address - Street 1:2777 E CAMELBACK RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4352
Practice Address - Country:US
Practice Address - Phone:602-952-0002
Practice Address - Fax:602-224-9119
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5045OtherSTATE LICENSE