Provider Demographics
NPI:1508993155
Name:MOSER, DANIELLE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ANN
Last Name:MOSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3743
Mailing Address - Country:US
Mailing Address - Phone:520-797-8885
Mailing Address - Fax:520-797-1912
Practice Address - Street 1:6127 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3743
Practice Address - Country:US
Practice Address - Phone:520-797-8885
Practice Address - Fax:520-797-1912
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant