Provider Demographics
NPI:1871089797
Name:DANIELS, LEVON
Entity type:Individual
Prefix:
First Name:LEVON
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BROADWAY ST APT K7
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4842
Mailing Address - Country:US
Mailing Address - Phone:601-951-8466
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY ST APT K7
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4842
Practice Address - Country:US
Practice Address - Phone:601-951-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty