Provider Demographics
NPI:1750985743
Name:MCDANIEL, JEAN LYNN
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:LYNN
Last Name:MCDANIEL
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 1:544 EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1706
Mailing Address - Country:US
Mailing Address - Phone:304-270-8669
Mailing Address - Fax:
Practice Address - Street 1:544 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1706
Practice Address - Country:US
Practice Address - Phone:304-270-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant