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NPI Code Detail

MEDICARE: MS. LACRETIA M DANIELS NP

MEDICARE: MS. LACRETIA M DANIELS 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
1363L00000XNurse Practitioner137786MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518103654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LACRETIA M DANIELS NP
Provider Business Mailing Address
First Line : PO BOX 959354
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-9354
Country : US
Telephone Number : 636-497-4055
Fax Number : 636-344-1069
Provider Business Practice Location Address
First Line : 1520 WENTZVILLE PKWY
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-3408
Country : US
Telephone Number : 636-497-4055
Fax Number : 636-344-1069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2008
Last Update Date : 09/25/2025

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