Provider Demographics
NPI:1316045362
Name:BURNELL, DANIEL MARK (BS, MA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARK
Last Name:BURNELL
Suffix:
Gender:M
Credentials:BS, MA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E NIAGARA RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5029
Mailing Address - Country:US
Mailing Address - Phone:970-497-4921
Mailing Address - Fax:855-855-4482
Practice Address - Street 1:1550 E NIAGARA RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5029
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:855-855-4482
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2002-0003NM363AM0700X
COPA.0004016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70256012Medicaid
NMMB0952704OtherFEDERAL DEA#
CO70256012Medicaid
NMQ23205Medicare UPIN