Provider Demographics
NPI:1184283558
Name:MCDANIEL, VIRGINIA (STNA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N MATHISON ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-2444
Mailing Address - Country:US
Mailing Address - Phone:937-699-0405
Mailing Address - Fax:
Practice Address - Street 1:345 N MATHISON ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-2444
Practice Address - Country:US
Practice Address - Phone:937-699-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321334Medicaid