MEDICARE: CARMELITA MCDANIELS

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	163WM0705X	Medical-Surgical Registered Nurse	RN132530	AZ

General Provider Information

NPI Number	:	1790541290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELITA MCDANIELS

Provider Business Mailing Address
First Line	:	4314 E WINDSONG DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0509
Country	:	US
Telephone Number	:	480-459-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 E WINDSONG DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0509
Country	:	US
Telephone Number	:	480-459-8730
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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