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General NPI Number Information
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NPI Number | 1861961989
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Entity Type | Individual
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Provider Name | ETOYUS DANIELS APRN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 1360 DOGWOOD DR SE STE 104
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City | CONYERS
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State | GA
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Zip | 30013-5077
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Country | US
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Telephone | 404-793-8210
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Fax | 404-793-8375
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Provider Business Mailing Address
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Address Line | 20 ANN CT
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City | COVINGTON
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State | GA
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Zip | 30016-6705
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Country | US
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Telephone | 404-451-4052
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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 | RN226360
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License Number State | GA
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