Provider Demographics
NPI:1285229351
Name:MYATT, DANA L (NMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:MYATT
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 N BEECH BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7524
Mailing Address - Country:US
Mailing Address - Phone:602-888-1287
Mailing Address - Fax:
Practice Address - Street 1:2535 N BEECH BLVD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7524
Practice Address - Country:US
Practice Address - Phone:602-888-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ90-405175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty