Provider Demographics
NPI:1871605519
Name:MCDANIEL, LAURA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:KONKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7664 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3309
Mailing Address - Country:US
Mailing Address - Phone:651-730-9884
Mailing Address - Fax:651-209-9283
Practice Address - Street 1:7664 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3309
Practice Address - Country:US
Practice Address - Phone:651-730-9884
Practice Address - Fax:651-209-9283
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1245107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse