Provider Demographics
NPI:1154389955
Name:DANIEL, LUCRETIA M (NP)
Entity type:Individual
Prefix:MRS
First Name:LUCRETIA
Middle Name:M
Last Name:DANIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LUCRETIA
Other - Middle Name:F
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 UNION AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6654
Practice Address - Country:US
Practice Address - Phone:901-525-0278
Practice Address - Fax:901-526-9014
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3903462Medicare ID - Type Unspecified
P33061Medicare UPIN