Provider Demographics
NPI:1003461039
Name:MCDANIEL, SHARLA DENICE
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:DENICE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5637
Mailing Address - Country:US
Mailing Address - Phone:918-360-2622
Mailing Address - Fax:
Practice Address - Street 1:2410 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5637
Practice Address - Country:US
Practice Address - Phone:918-360-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator