Provider Demographics
NPI:1790003200
Name:MYRTIL, DAPHNEY
Entity Type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:
Last Name:MYRTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 500 S
Mailing Address - Street 2:APT 419
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3361
Mailing Address - Country:US
Mailing Address - Phone:718-208-9397
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST,
Practice Address - Street 2:CHE 7TH FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program