Provider Demographics
NPI:1205476579
Name:ANDERSEN, DANIELLE (MS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 E CAMELBACK RD STE 120-190
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4126
Mailing Address - Country:US
Mailing Address - Phone:402-867-4456
Mailing Address - Fax:
Practice Address - Street 1:7344 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7456
Practice Address - Country:US
Practice Address - Phone:480-751-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath