Provider Demographics
NPI:1164577789
Name:MCDANIEL, NADINE MARIE (SLP-CF)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:MARIE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7623 VIA SERENO SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8838
Mailing Address - Country:US
Mailing Address - Phone:505-344-4204
Mailing Address - Fax:
Practice Address - Street 1:4505 BALI CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2801
Practice Address - Country:US
Practice Address - Phone:505-264-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-3933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC-3933OtherSLP CLINICAL FELLOW