Provider Demographics
NPI:1376790576
Name:DANIEL, KATHERINE (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 5210
Mailing Address - Street 2:BOX 230
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-0230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RAF LAKENHEATH
Practice Address - Street 2:BOX 230 UNIT 5210
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-0230
Practice Address - Country:US
Practice Address - Phone:314-238-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10898171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider