Provider Demographics
NPI:1932771292
Name:TEAGUE-DANIEL, LANESHA
Entity Type:Individual
Prefix:
First Name:LANESHA
Middle Name:
Last Name:TEAGUE-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 1:129 LEAFMORE RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-3812
Mailing Address - Country:US
Mailing Address - Phone:706-766-4121
Mailing Address - Fax:
Practice Address - Street 1:309 GRADY AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5544
Practice Address - Country:US
Practice Address - Phone:706-766-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN097072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse