Provider Demographics
NPI:1619624830
Name:DANIEL, IMAN SERENA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:IMAN
Middle Name:SERENA
Last Name:DANIEL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 CREEK VALE WAY APT 2C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9497
Mailing Address - Country:US
Mailing Address - Phone:563-508-2699
Mailing Address - Fax:
Practice Address - Street 1:6821 CREEK VALE WAY APT 2C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9497
Practice Address - Country:US
Practice Address - Phone:563-508-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28247425A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse