Provider Demographics
NPI:1942641535
Name:MCDANIEL, GWENDOLYN DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DAWN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 CHURCHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1248
Mailing Address - Country:US
Mailing Address - Phone:513-709-9262
Mailing Address - Fax:
Practice Address - Street 1:6307 CHURCHVIEW LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1248
Practice Address - Country:US
Practice Address - Phone:513-709-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.150748-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse