Provider Demographics
NPI:1801342621
Name:DANIELS, WILLIAM JR (BS, EPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DANIELS
Suffix:JR
Gender:M
Credentials:BS, EPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:STINESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47464
Mailing Address - Country:US
Mailing Address - Phone:317-626-2401
Mailing Address - Fax:
Practice Address - Street 1:600 N. JORDAN AVE.
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405
Practice Address - Country:US
Practice Address - Phone:812-855-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35 6001673OtherIU HEALTH CENTER