Provider Demographics
NPI:1376115048
Name:DANIELS, JESSICA NICHOL
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOL
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-1504
Mailing Address - Country:US
Mailing Address - Phone:304-476-4397
Mailing Address - Fax:
Practice Address - Street 1:1719 N 20TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-1504
Practice Address - Country:US
Practice Address - Phone:304-476-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant