Provider Demographics
NPI:1912057266
Name:MCDANIEL, DONALD EARL II (CRNA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EARL
Last Name:MCDANIEL
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:41049-8839
Mailing Address - Country:US
Mailing Address - Phone:606-876-2678
Mailing Address - Fax:
Practice Address - Street 1:920 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9209
Practice Address - Country:US
Practice Address - Phone:606-849-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP21706Medicare UPIN
KY3321714Medicare ID - Type Unspecified