Provider Demographics
NPI:1598013229
Name:DANIELS, JACQUELINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
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 1:240 SHERWOOD FOREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1308
Mailing Address - Country:US
Mailing Address - Phone:845-775-9974
Mailing Address - Fax:
Practice Address - Street 1:240 SHERWOOD FOREST DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1308
Practice Address - Country:US
Practice Address - Phone:845-775-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296475164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse