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General NPI Number Information
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NPI Number | 1821552068
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Entity Type | Individual
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Provider Name | SHONTE' PATRICE DANIELS
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 107 FRONT ST STE 2134
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City | VIDALIA
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State | LA
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Zip | 71373-2834
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Country | US
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Telephone | 318-336-2212
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Fax | 318-336-6067
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Provider Business Mailing Address
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Address Line | 354 DEACON WAILES RD
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City | FERRIDAY
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State | LA
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Zip | 71334-4300
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Country | US
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Telephone | 713-247-9574
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F08180268
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License Number State | LA
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