Provider Demographics
NPI:1578994240
Name:DANIELS, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 KINGOLD BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1303
Mailing Address - Country:US
Mailing Address - Phone:252-747-8181
Mailing Address - Fax:252-747-8946
Practice Address - Street 1:227 KINGOLD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251665163W00000X, 163WC1500X, 163WI0600X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory