Provider Demographics
NPI:1689718264
Name:NANCE, DANIELLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:NANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:NANCE
Other - Last Name:STUEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2940 E. BANNER GATEWAY DRIVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-3430
Mailing Address - Fax:480-256-3682
Practice Address - Street 1:2946 E. BANNER GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-256-6444
Practice Address - Fax:480-256-3682
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60095890207R00000X, 204R00000X
UT8236478-1205207RH0000X
AZ50742207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1689718264Medicaid