Provider Demographics
NPI:1679949697
Name:DANIELS, MICHELLE LADAWN (OFFICE MANGER/OWNER)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LADAWN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:OFFICE MANGER/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16124 SE CR 2375
Mailing Address - Street 2:
Mailing Address - City:STREETMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75859
Mailing Address - Country:US
Mailing Address - Phone:903-288-7084
Mailing Address - Fax:903-599-2798
Practice Address - Street 1:16124 SE COUNTY ROAD 2375
Practice Address - Street 2:
Practice Address - City:STREETMAN
Practice Address - State:TX
Practice Address - Zip Code:75859-7148
Practice Address - Country:US
Practice Address - Phone:903-288-7084
Practice Address - Fax:903-599-2798
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX472731403343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)