Basic Information
| Provider Information | |||||||||
| NPI: | 1649736885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11102 WAKEFIELD DR S | ||||||||
| Address2: | |||||||||
| City: | SAINT FRANCISVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707754826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257213811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2019 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP203455 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.