Provider Demographics
NPI:1942486014
Name:DANIEL, SUSAN RENEA (MSN, APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RENEA
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3258
Mailing Address - Country:US
Mailing Address - Phone:270-691-8040
Mailing Address - Fax:
Practice Address - Street 1:811 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3258
Practice Address - Country:US
Practice Address - Phone:270-691-8040
Practice Address - Fax:270-691-8049
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005420364SA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000617640OtherCOOP HEALTH BCBS #
KY7100039400Medicaid
KY000000586343OtherBCBS
KY0992322OtherMEDICARE
KY7100039400Medicaid
KY000000617640OtherCOOP HEALTH BCBS #