Provider Demographics
NPI:1588616940
Name:DANNER, BRIDGIT BEASLEY (LAC)
Entity type:Individual
Prefix:MS
First Name:BRIDGIT
Middle Name:BEASLEY
Last Name:DANNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 W BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7534
Mailing Address - Country:US
Mailing Address - Phone:971-533-2332
Mailing Address - Fax:
Practice Address - Street 1:21001 N TATUM BLVD STE 78-1640
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-5244
Practice Address - Country:US
Practice Address - Phone:480-255-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00793171100000X
AZLAC-012155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist