Provider Demographics
NPI:1558791160
Name:DANIELS, DEBORAH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUGAR NATION DR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-9327
Mailing Address - Country:US
Mailing Address - Phone:843-782-0031
Mailing Address - Fax:843-782-0042
Practice Address - Street 1:150 COUGAR NATION DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-9327
Practice Address - Country:US
Practice Address - Phone:843-782-0031
Practice Address - Fax:843-782-0042
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP25791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse