Provider Demographics
NPI:1134762909
Name:DANIELS, KEIMEADRICK NICOLE
Entity type:Individual
Prefix:
First Name:KEIMEADRICK
Middle Name:NICOLE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SE MILE HILL DR # 114-53
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3554
Mailing Address - Country:US
Mailing Address - Phone:425-399-4339
Mailing Address - Fax:
Practice Address - Street 1:1700 SE MILE HILL DR # 114-53
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3554
Practice Address - Country:US
Practice Address - Phone:425-399-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide