Provider Demographics
NPI:1811157878
Name:DANIEL, HEATHER C (ACNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:DANIEL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 MCKNIGHT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4890
Mailing Address - Country:US
Mailing Address - Phone:513-217-6400
Mailing Address - Fax:513-217-6037
Practice Address - Street 1:103 MCKNIGHT DR
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4890
Practice Address - Country:US
Practice Address - Phone:513-217-6400
Practice Address - Fax:513-217-6037
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN291112363LA2100X
OHNP10007363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000579144OtherANTHEM
OHP00812023OtherRAIL ROAD
OH208679830037OtherCARESOURCE
OH00310523OtherAMERIGROUP
OH2867045Medicaid
OH1811157878OtherMEDICAL MUTUAL
OH1811157878OtherMEDICAL MUTUAL
OH$$$$$$$$$00OtherBWC