Provider Demographics
NPI:1336761303
Name:EMBORSKY, DANIEL JAMES JR (MSN RN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:EMBORSKY
Suffix:JR
Gender:M
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 PROSPECTOR ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-1900
Mailing Address - Country:US
Mailing Address - Phone:928-753-6216
Mailing Address - Fax:928-753-4042
Practice Address - Street 1:3550 PROSPECTOR ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-1900
Practice Address - Country:US
Practice Address - Phone:928-753-6216
Practice Address - Fax:928-753-4042
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN132974163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool