Individual
LISA MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3499 S MERCY RD, GILBERT, AZ 85297-0437
(480) 355-8525
(480) 355-3115
Mailing address
PO BOX 756, GILBERT, AZ 85299-0756
(480) 355-8525
(480) 355-3115
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3546
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031813
MEDICARE
AZ
01
—
031814
MEDICARE
AZ
01
—
031815
MEDICARE
AZ
01
—
031820
MEDICARE
AZ
05
—
183792
—
AZ
01
—
3546
STATE LICENSE
AZ
Enumeration date
11/14/2006
Last updated
11/07/2013
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