Provider Demographics
NPI:1215037288
Name:DANIELS, REBECCA GOLDEN (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GOLDEN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:G
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:42440 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:NORTH OAKS PEDIATRIC CLINIC, LLP
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-542-4950
Mailing Address - Fax:985-542-6089
Practice Address - Street 1:42440 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:NORTH OAKS PEDIATRIC CLINIC, LLP
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-4950
Practice Address - Fax:985-542-6089
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR664731363LF0000X
LAAP04012/RN102076363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1691691Medicaid
MS04772801Medicaid
MS512I500371Medicare PIN