Provider Demographics
NPI:1760463228
Name:MCDANIEL, LEE ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
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 1:20 CLEAR CREEK RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROSSTON
Mailing Address - State:TX
Mailing Address - Zip Code:76263-2530
Mailing Address - Country:US
Mailing Address - Phone:260-251-0458
Mailing Address - Fax:
Practice Address - Street 1:1600 11TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4300
Practice Address - Country:US
Practice Address - Phone:940-764-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146064367500000X
TX1033522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200248750Medicaid
IN200248750Medicaid
IN215530IMedicare PIN
INCC9320DMedicare PIN