Individual
DANIELLE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1744 S VAL VISTA DR STE 5-108, MESA, AZ 85204-7362
(888) 663-6631
(415) 252-7176
Mailing address
253 N PIEDRA, MESA, AZ 85207-7561
(262) 366-0419
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8028
AZ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/06/2020
Last updated
03/17/2025
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