Healthcare Provider Details

I. General information

NPI: 1215200761
Provider Name (Legal Business Name): LELA DANIEL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 W GRAND BLVD
DETROIT MI
48208-1105
US

IV. Provider business mailing address

2051 W GRAND BLVD
DETROIT MI
48208-1105
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-3695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704158749
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: