Provider Demographics
NPI:1275737884
Name:MCDANIEL-MASSEY, GLORIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:MCDANIEL-MASSEY
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 1:2220 MARY ANN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2840
Mailing Address - Country:US
Mailing Address - Phone:704-334-7311
Mailing Address - Fax:704-335-9790
Practice Address - Street 1:1900 RANDOLPH RD STE 1010
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1117
Practice Address - Country:US
Practice Address - Phone:704-334-7311
Practice Address - Fax:704-335-9790
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC031522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse