Provider Demographics
NPI:1235485483
Name:MCDANIELS, MONICA (MS, LDN, RD)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:F
Credentials:MS, LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 SYCAMORE RDG
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-5433
Mailing Address - Country:US
Mailing Address - Phone:225-342-7988
Mailing Address - Fax:225-342-8312
Practice Address - Street 1:628 N 4TH ST
Practice Address - Street 2:BIN #4 ROOM 358
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5342
Practice Address - Country:US
Practice Address - Phone:225-342-7988
Practice Address - Fax:225-342-8312
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA840500133V00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered