Provider Demographics
NPI:1992518880
Name:MCDANIEL, MARY LATINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LATINA
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 GREENFIELD ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1315
Mailing Address - Country:US
Mailing Address - Phone:319-640-4304
Mailing Address - Fax:
Practice Address - Street 1:700 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-4317
Practice Address - Country:US
Practice Address - Phone:319-640-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF12240885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily