Healthcare Provider Details

I. General information

NPI: 1174783062
Provider Name (Legal Business Name): JACQUELINE J MCDANIEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE JONES MCDANIEL FNP

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JEFFERSON AVE
WASHINGTON PA
15301-4119
US

IV. Provider business mailing address

640 JEFFERSON AVE
WASHINGTON PA
15301-4119
US

V. Phone/Fax

Practice location:
  • Phone: 724-222-6603
  • Fax: 724-222-8565
Mailing address:
  • Phone: 724-222-6603
  • Fax: 724-222-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009654
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number57826
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.10579
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP009654
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: