Provider Demographics
NPI:1639598030
Name:DANIEL, OMEGA D (RNFA,SA-C)
Entity Type:Individual
Prefix:
First Name:OMEGA
Middle Name:D
Last Name:DANIEL
Suffix:
Gender:F
Credentials:RNFA,SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44449 PINE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1254
Mailing Address - Country:US
Mailing Address - Phone:207-227-6504
Mailing Address - Fax:
Practice Address - Street 1:44449 PINE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1254
Practice Address - Country:US
Practice Address - Phone:207-227-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287681163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant