Provider Demographics
NPI:1801225594
Name:KRONEMEYER, DANIEL JAYSON
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAYSON
Last Name:KRONEMEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 6TH DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2316
Mailing Address - Country:US
Mailing Address - Phone:480-560-3802
Mailing Address - Fax:
Practice Address - Street 1:530 W 6TH DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2316
Practice Address - Country:US
Practice Address - Phone:480-560-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6354A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility