Provider Demographics
NPI:1457636698
Name:MCDANIEL, CORRIE (DO)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-7370
Mailing Address - Fax:206-985-3201
Practice Address - Street 1:2800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:708-684-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 60466840208000000X, 208000000X
WA60466840208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist