Provider Demographics
NPI:1699230441
Name:DANIEL, MARCY D
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:D
Last Name:DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KONGIGANUK
Mailing Address - State:AK
Mailing Address - Zip Code:99545
Mailing Address - Country:US
Mailing Address - Phone:907-557-5127
Mailing Address - Fax:907-557-5620
Practice Address - Street 1:23 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KONGIGANUK
Practice Address - State:AK
Practice Address - Zip Code:99545
Practice Address - Country:US
Practice Address - Phone:907-557-5127
Practice Address - Fax:907-557-5620
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker