Provider Demographics
NPI:1043987746
Name:DANIEL, ANNE LAUREN
Entity type:Individual
Prefix:
First Name:ANNE LAUREN
Middle Name:
Last Name:DANIEL
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 1:6001 SILTSTONE LN APT 1113
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-8024
Mailing Address - Country:US
Mailing Address - Phone:505-907-8284
Mailing Address - Fax:
Practice Address - Street 1:6001 SILTSTONE LN APT 1113
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-8024
Practice Address - Country:US
Practice Address - Phone:505-907-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046249363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner