Provider Demographics
NPI:1558410332
Name:MCCOOL, DARLA JEAN (LVN)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:JEAN
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21777 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8502
Mailing Address - Country:US
Mailing Address - Phone:951-784-6145
Mailing Address - Fax:
Practice Address - Street 1:8038 LAUREL PARK CIR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4096
Practice Address - Country:US
Practice Address - Phone:951-360-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN170819164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN002670Medicaid