Provider Demographics
NPI:1134861933
Name:DANIELS, GLENN B
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:B
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-0791
Mailing Address - Country:US
Mailing Address - Phone:984-302-7180
Mailing Address - Fax:
Practice Address - Street 1:1598 HWY56
Practice Address - Street 2:SUITE 4
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8126
Practice Address - Country:US
Practice Address - Phone:919-964-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)