Provider Demographics
NPI:1114356755
Name:DANIELS, MARY FLORENCE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FLORENCE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-3423
Mailing Address - Country:US
Mailing Address - Phone:229-214-3024
Mailing Address - Fax:
Practice Address - Street 1:102 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-3423
Practice Address - Country:US
Practice Address - Phone:229-214-3024
Practice Address - Fax:229-430-1719
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse