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General NPI Number Information
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NPI Number | 1245649029
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Entity Type | Individual
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Provider Name | MARK DANIELS PCNP
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Gender | Male
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 340 9TH ST
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City | FLORENCE
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State | OR
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Zip | 97439
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Country | US
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Telephone | 541-902-1634
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Fax | 541-902-9702
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Provider Business Mailing Address
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Address Line | 1115 SE 164TH AVE DEPT 358
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City | VANCOUVER
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State | WA
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Zip | 98683-8004
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Country | US
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Telephone | 360-729-1412
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Fax | 360-729-3025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53268
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 201402362RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201810942NP-PP
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License Number State | OR
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