Provider Demographics
NPI:1720613383
Name:MCDANIEL, ANDREA (MS, RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 W JACARANDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3373
Mailing Address - Country:US
Mailing Address - Phone:402-960-2580
Mailing Address - Fax:
Practice Address - Street 1:4216 W JACARANDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3373
Practice Address - Country:US
Practice Address - Phone:402-960-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1002573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered