Provider Demographics
NPI:1598803934
Name:MCDANIEL, MIRIAM (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 JUNIPER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-3375
Mailing Address - Country:US
Mailing Address - Phone:251-867-4219
Mailing Address - Fax:
Practice Address - Street 1:1301 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1306
Practice Address - Country:US
Practice Address - Phone:251-809-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079087367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered