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NPI Code Detail

MEDICARE: DANIEL GUNNAR MCDERMOTT RN, BSN

MEDICARE:   DANIEL GUNNAR MCDERMOTT  RN, BSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN2325702MA

General Provider Information

NPI Number : 1649753013
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL GUNNAR MCDERMOTT RN, BSN
Provider Business Mailing Address
First Line : 604 FORT WORTH AVE APT 2139
Second Line :
City : DALLAS
State : TX
Zip : 75208-0259
Country : US
Telephone Number : 774-571-7867
Fax Number :
Provider Business Practice Location Address
First Line : 604 FORT WORTH AVE APT 2139
Second Line :
City : DALLAS
State : TX
Zip : 75208-0259
Country : US
Telephone Number : 774-571-7867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 09/12/2018

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Directions to “ DANIEL GUNNAR MCDERMOTT RN, BSN” Practice Location

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