Provider Demographics
NPI:1669298808
Name:DANIEL, ADDIE B
Entity type:Individual
Prefix:
First Name:ADDIE
Middle Name:B
Last Name:DANIEL
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 1:1313 STARDUST AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3096
Mailing Address - Country:US
Mailing Address - Phone:330-328-1260
Mailing Address - Fax:
Practice Address - Street 1:1313 STARDUST AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3096
Practice Address - Country:US
Practice Address - Phone:330-328-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)