Individual
JACQUELIN S DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1508 K-V ROAD, VICTORIA, VA 23974
(434) 696-2165
(434) 696-1577
Mailing address
1508 K-V ROAD, VICTORIA, VA 23974
(434) 696-2165
(434) 696-1557
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024164095
VA
363LW0102X
Women's Health Nurse Practitioner
0024164095
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010025788
VA PREMIER KB
VA
05
—
010025788
—
VA
01
—
010105510
VA PREMIER
VA
05
—
010105510
—
VA
05
—
010252881
—
VA
01
—
187620
MEDCOST
VA
01
—
187697
MEDCOST KB
VA
01
—
187699
MEDCOST CC
VA
01
—
224189800
DOL
VA
01
—
7000967
NC MEDICAID
VA
Enumeration date
06/20/2005
Last updated
10/11/2012
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