Provider Demographics
NPI:1104131671
Name:DANIEL, KAREN RENEE (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4530 BAY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WARTHEN
Mailing Address - State:GA
Mailing Address - Zip Code:31094-4122
Mailing Address - Country:US
Mailing Address - Phone:678-371-4655
Mailing Address - Fax:770-582-4189
Practice Address - Street 1:4530 BAY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WARTHEN
Practice Address - State:GA
Practice Address - Zip Code:31094-4122
Practice Address - Country:US
Practice Address - Phone:678-371-4655
Practice Address - Fax:770-582-4189
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0610250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily