Healthcare Provider Details

I. General information

NPI: 1891955753
Provider Name (Legal Business Name): ELIZABETH OGLES MCDANIEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S MEMORIAL DR
PRATTVILLE AL
36067-3619
US

IV. Provider business mailing address

PO BOX 2324
BIRMINGHAM AL
35201-2324
US

V. Phone/Fax

Practice location:
  • Phone: 334-365-0651
  • Fax: 818-587-2493
Mailing address:
  • Phone: 877-812-7003
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1093938
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: