Provider Demographics
NPI:1871154484
Name:DANIELS, LACI AHNE (RN)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:AHNE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ANDERSON LN
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-2283
Mailing Address - Country:US
Mailing Address - Phone:607-743-3152
Mailing Address - Fax:
Practice Address - Street 1:15 PEARL ST E
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1597
Practice Address - Country:US
Practice Address - Phone:607-561-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674982163WC0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine