MEDICARE: MRS. TERI WAIALA DANIELS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1124954961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERI WAIALA DANIELS

Provider Business Mailing Address
First Line	:	903 ROAD B UNIT 10
Second Line	:
City	:	HENDERSON
State	:	NE
Zip	:	68371-8951
Country	:	US
Telephone Number	:	785-810-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 W OKLAHOMA AVE STE 2
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-6781
Country	:	US
Telephone Number	:	308-381-1690
Fax Number	:

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

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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