Provider Demographics
NPI:1316959844
Name:DANIELS, ANNE E (CNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SUNRISE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-325-5145
Mailing Address - Fax:
Practice Address - Street 1:2804 E 20TH ST
Practice Address - Street 2:PPRM
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-327-0451
Practice Address - Fax:505-325-0933
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAPRN-CNP01332363LW0102X
MA197751363LW0102X
NMR55481363LW0102X
NVAPRNCNP823912363LW0102X
COCAPN0001547CNP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR5094Medicaid
CO9000173842Medicaid