MEDICARE: KAREN RENEE DANIEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F0610250	GA

General Provider Information

NPI Number	:	1104131671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN RENEE DANIEL NP

Provider Business Mailing Address
First Line	:	4530 BAY SPRINGS RD
Second Line	:
City	:	WARTHEN
State	:	GA
Zip	:	31094-4122
Country	:	US
Telephone Number	:	678-371-4655
Fax Number	:	770-582-4189

Provider Business Practice Location Address
First Line	:	4530 BAY SPRINGS RD
Second Line	:
City	:	WARTHEN
State	:	GA
Zip	:	31094-4122
Country	:	US
Telephone Number	:	678-371-4655
Fax Number	:	770-582-4189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	07/28/2015

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