Healthcare Provider Details

I. General information

NPI: 1194293985
Provider Name (Legal Business Name): DONALD DANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

2622 N MORELAND BLVD APT 18
CLEVELAND OH
44120-1484
US

V. Phone/Fax

Practice location:
  • Phone: 915-867-7873
  • Fax:
Mailing address:
  • Phone: 915-867-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.024142
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number430927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: