Provider Demographics
NPI:1750894184
Name:DENSLEY, DANIEL JACOB (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:DENSLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:925 WELLS AVENUE
Practice Address - Street 2:P.O. BOX 3520
Practice Address - City:WEST WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883-3520
Practice Address - Country:US
Practice Address - Phone:775-664-2220
Practice Address - Fax:775-664-2965
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6010580-1206363AM0700X
NVPA1899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1899OtherNEVADA PHYSICIAN ASSISTANT LICENSE