Provider Demographics
NPI:1740632892
Name:DANETTE DEHNICKE
Entity type:Organization
Organization Name:DANETTE DEHNICKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHNICKE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:480-580-2194
Mailing Address - Street 1:4206 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5431
Mailing Address - Country:US
Mailing Address - Phone:480-580-2194
Mailing Address - Fax:
Practice Address - Street 1:4206 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5431
Practice Address - Country:US
Practice Address - Phone:480-580-2194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-814175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty