Provider Demographics
NPI:1184635005
Name:PUTROW, DANIELLE T (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:T
Last Name:PUTROW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:T
Other - Last Name:JURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6153
Mailing Address - Country:US
Mailing Address - Phone:480-775-4240
Mailing Address - Fax:480-775-8866
Practice Address - Street 1:1600 W CHANDLER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6153
Practice Address - Country:US
Practice Address - Phone:480-775-4240
Practice Address - Fax:480-775-8866
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN097910363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health