Organization
MICA MCDANIEL FNP-C, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICA MCDANIEL FNPC (OWNER / AUTHORIZED OFFICIAL)
(318) 308-4447
Entity
Organization
Contact information
Practice address
1420 BLANKENSHIP DR, DERIDDER, LA 70634
(337) 460-9472
Mailing address
PO BOX 276, ELIZABETH, LA 70638-0276
(318) 308-4447
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN088334
LA
Other
Enumeration date
01/24/2018
Last updated
05/17/2018
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