Provider Demographics
NPI:1376611541
Name:DANIELS, PENELOPE L (CFNP)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:L
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25709
Mailing Address - Country:US
Mailing Address - Phone:304-525-7801
Mailing Address - Fax:304-522-0686
Practice Address - Street 1:1530 NORWAY AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25709
Practice Address - Country:US
Practice Address - Phone:304-525-7801
Practice Address - Fax:304-522-0686
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001837Medicaid
DAN77781Medicare ID - Type Unspecified
Q36790Medicare UPIN