Provider Demographics
NPI:1487112785
Name:MCDANIEL, MONICA SIMONE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SIMONE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6643 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3351
Mailing Address - Country:US
Mailing Address - Phone:334-538-4667
Mailing Address - Fax:
Practice Address - Street 1:6649 PINEBROOK DR
Practice Address - Street 2:2507 MADISON AVENUE
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-3351
Practice Address - Country:US
Practice Address - Phone:334-538-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)