Provider Demographics
NPI:1518103654
Name:DANIELS, LACRETIA M (ANP)
Entity Type:Individual
Prefix:MS
First Name:LACRETIA
Middle Name:M
Last Name:DANIELS
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8031
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-2700
Mailing Address - Fax:314-286-2701
Practice Address - Street 1:6 MILLSTONE CAMPUS DR
Practice Address - Street 2:STE 1000
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5775
Practice Address - Country:US
Practice Address - Phone:314-273-4374
Practice Address - Fax:314-983-0155
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2021-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO137786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427204102Medicaid