Provider Demographics
NPI:1972135861
Name:MCDANIEL, VICKIE COLLEEN
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:COLLEEN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-0407
Mailing Address - Country:US
Mailing Address - Phone:440-474-2890
Mailing Address - Fax:
Practice Address - Street 1:12990 NELSON LEDGE RD LOT B2
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9627
Practice Address - Country:US
Practice Address - Phone:440-474-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400769130608376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide