Provider Demographics
NPI:1215349089
Name:DANIELS, AJA S (LPN)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:S
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 TRINITY WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-8664
Mailing Address - Country:US
Mailing Address - Phone:330-978-4021
Mailing Address - Fax:
Practice Address - Street 1:823 TRINITY WAY
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-8664
Practice Address - Country:US
Practice Address - Phone:330-978-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171714164W00000X
OH400092260302374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse