Provider Demographics
NPI:1528021177
Name:DANIEL, JANICE B (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:B
Last Name:DANIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:B
Other - Last Name:DEBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 SHELTON RD
Mailing Address - Street 2:
Mailing Address - City:STOKESDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27357-8204
Mailing Address - Country:US
Mailing Address - Phone:336-408-9484
Mailing Address - Fax:
Practice Address - Street 1:1510 NC HIGHWAY 68 N
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9733
Practice Address - Country:US
Practice Address - Phone:336-644-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201192363L00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004186Medicaid
P08032Medicare UPIN
NC7004186Medicaid