Provider Demographics
NPI:1063624963
Name:MCDANIEL, ANNETTE MARIE (NP-C, RN-BC)
Entity type:Individual
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First Name:ANNETTE
Middle Name:MARIE
Last Name:MCDANIEL
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Gender:F
Credentials:NP-C, RN-BC
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7880
Practice Address - Fax:317-887-7660
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71002393A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201011540Medicaid
INP01210186OtherRR MEDICARE PTAN
IN201011540Medicaid