Provider Demographics
NPI:1073836466
Name:DANIEL, MARY MICHAEL (APN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHAEL
Last Name:DANIEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 E CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-1225
Mailing Address - Country:US
Mailing Address - Phone:479-795-1301
Mailing Address - Fax:479-795-1304
Practice Address - Street 1:1225 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-1225
Practice Address - Country:US
Practice Address - Phone:479-795-1301
Practice Address - Fax:479-795-1304
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily