Provider Demographics
NPI:1699595421
Name:MCDANIEL, NOVICE (PHD)
Entity type:Individual
Prefix:MRS
First Name:NOVICE
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 RONSTAN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-1453
Mailing Address - Country:US
Mailing Address - Phone:254-458-6920
Mailing Address - Fax:
Practice Address - Street 1:1610 RONSTAN DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-1453
Practice Address - Country:US
Practice Address - Phone:254-458-6920
Practice Address - Fax:855-635-8256
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment