Provider Demographics
NPI:1124517099
Name:DANIELS, PORTIA (RN, NP)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:PORTIA
Other - Middle Name:
Other - Last Name:NERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:4820 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1696
Mailing Address - Country:US
Mailing Address - Phone:707-224-8266
Mailing Address - Fax:
Practice Address - Street 1:2300 NORTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5004
Practice Address - Country:US
Practice Address - Phone:707-224-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022044363LP0808X
CA95159820163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health