Healthcare Provider Details

I. General information

NPI: 1124954961
Provider Name (Legal Business Name): MRS. TERI WAIALA DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. WAIALA DANIELS

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W OKLAHOMA AVE STE 2
GRAND ISLAND NE
68801-6781
US

IV. Provider business mailing address

903 ROAD B UNIT 10
HENDERSON NE
68371-8951
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-1690
  • Fax:
Mailing address:
  • Phone: 785-810-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: