Provider Demographics
NPI:1346537487
Name:DANIELS, GEORGE MONROE (RN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MONROE
Last Name:DANIELS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 PIPER DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1318
Mailing Address - Country:US
Mailing Address - Phone:608-347-6060
Mailing Address - Fax:
Practice Address - Street 1:537 PIPER DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1318
Practice Address - Country:US
Practice Address - Phone:608-347-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102223-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI102223-30OtherREGISTERED NURSE
WIXPH2N37GZMedicaid