Provider Demographics
NPI:1083860456
Name:MCDANIEL, JILL M (LMP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 IVY ST NE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1734
Mailing Address - Country:US
Mailing Address - Phone:509-754-4511
Mailing Address - Fax:
Practice Address - Street 1:100 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1602
Practice Address - Country:US
Practice Address - Phone:509-754-9374
Practice Address - Fax:509-754-9374
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist