Healthcare Provider Details

I. General information

NPI: 1225797863
Provider Name (Legal Business Name): ALICIA MCDANIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA MENDENHALL

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARQUETTE ST
VALPARAISO IN
46383-2508
US

IV. Provider business mailing address

501 MARQUETTE ST
VALPARAISO IN
46383-2508
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-5195
  • Fax: 219-548-0945
Mailing address:
  • Phone: 219-462-5195
  • Fax: 219-548-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number7014651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: