Provider Demographics
NPI:1437217023
Name:MCDANIEL, DIANE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LOUISE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:HUDSON
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6428 W TULARE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1174
Mailing Address - Country:US
Mailing Address - Phone:520-572-8328
Mailing Address - Fax:520-572-8328
Practice Address - Street 1:6428 W TULARE WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-1174
Practice Address - Country:US
Practice Address - Phone:520-572-8328
Practice Address - Fax:520-572-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4607385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child