Basic Information
| Provider Information | |||||||||
| NPI: | 1285053496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | BRIANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 NEW CAMELLIA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1985277546 | ||||||||
| FaxNumber: | 9852775463 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 NEW CAMELLIA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853707546 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 307882 | LA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2479946 | 05 | LA | MEDICAID |