Provider Demographics
NPI:1730317470
Name:DANIELS, LORI ASHLI (CRNA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ASHLI
Last Name:DANIELS
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 1:3655 MITCHELL ST
Mailing Address - Street 2:BOX 690001
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-9601
Mailing Address - Country:US
Mailing Address - Phone:843-716-7000
Mailing Address - Fax:843-716-7093
Practice Address - Street 1:3655 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-9601
Practice Address - Country:US
Practice Address - Phone:843-716-7000
Practice Address - Fax:843-716-7093
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3929OtherSC STATE LIC NUMBER