Provider Demographics
NPI:1295792547
Name:MCDANIEL, DANA L (APN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N RIVERSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2566
Mailing Address - Country:US
Mailing Address - Phone:816-271-1301
Mailing Address - Fax:816-271-1302
Practice Address - Street 1:902 NO RIVERSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2559
Practice Address - Country:US
Practice Address - Phone:816-271-1301
Practice Address - Fax:816-271-1302
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF0206160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295792547Medicaid
KS200590610BMedicaid
MOMA2554006Medicare PIN
KS110621009Medicare PIN