Provider Demographics
NPI:1417991092
Name:PRINCE ROSENKRANS, DANIELLE DAVIDA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DAVIDA
Last Name:PRINCE ROSENKRANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W RAY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2472
Mailing Address - Country:US
Mailing Address - Phone:888-488-7640
Mailing Address - Fax:602-783-1026
Practice Address - Street 1:3100 W RAY RD STE 201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2472
Practice Address - Country:US
Practice Address - Phone:888-488-7640
Practice Address - Fax:602-783-1026
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ68929207Q00000X
IA31352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42128384914Medicaid
IA48631OtherWELLMARK BCBS IA
IA1131003Medicaid
IA7784540Medicaid
IA1131003Medicaid
IA080138664Medicare ID - Type UnspecifiedRR MEDICARE
IA04912Medicare PIN