Provider Demographics
NPI:1952970154
Name:DAIGLE, JOSHUA ANDREW
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANDREW
Last Name:DAIGLE
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 1:3640 S CHRISTINE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2038
Mailing Address - Country:US
Mailing Address - Phone:774-722-0501
Mailing Address - Fax:
Practice Address - Street 1:3640 S CHRISTINE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2038
Practice Address - Country:US
Practice Address - Phone:774-722-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10674941-3102163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty