Provider Demographics
NPI:1104979061
Name:DANIELS, DELOIS (APRN)
Entity type:Individual
Prefix:MRS
First Name:DELOIS
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 REVOLUTIONARY TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827-7109
Mailing Address - Country:US
Mailing Address - Phone:803-632-2533
Mailing Address - Fax:803-632-3285
Practice Address - Street 1:333 REVOLUTIONARY TRL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:SC
Practice Address - Zip Code:29827-7109
Practice Address - Country:US
Practice Address - Phone:803-632-2533
Practice Address - Fax:803-632-3285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC830363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health