Provider Demographics
NPI:1366995961
Name:DANNEMILLER, THOMAS (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DANNEMILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18677 W VISTA NORTE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7579
Mailing Address - Country:US
Mailing Address - Phone:701-818-8553
Mailing Address - Fax:
Practice Address - Street 1:25555 W DURANGO ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9176
Practice Address - Country:US
Practice Address - Phone:623-925-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN188414163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool