Healthcare Provider Details

I. General information

NPI: 1558775106
Provider Name (Legal Business Name): DARNIQUA MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W AVENUE K4 APT 202
LANCASTER CA
93536-5432
US

IV. Provider business mailing address

3121 W AVENUE K4 APT 202
LANCASTER CA
93536-5432
US

V. Phone/Fax

Practice location:
  • Phone: 818-288-8518
  • Fax:
Mailing address:
  • Phone: 818-288-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN248286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: