Provider Demographics
NPI:1174783062
Name:MCDANIEL, JACQUELINE J (CRNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:JONES
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:640 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4119
Mailing Address - Country:US
Mailing Address - Phone:724-222-6603
Mailing Address - Fax:724-222-8565
Practice Address - Street 1:640 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4119
Practice Address - Country:US
Practice Address - Phone:724-222-6603
Practice Address - Fax:724-222-8565
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009654363LF0000X, 363LP0808X
WV57826363LP0808X
OHAPRN.CNP.10579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143554XRNMedicare PIN