Provider Demographics
NPI:1144557745
Name:MCDANIEL, ALLISON IVY (NMD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:IVY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 N 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1102
Mailing Address - Country:US
Mailing Address - Phone:602-509-0033
Mailing Address - Fax:602-923-8996
Practice Address - Street 1:11832 N 25TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1102
Practice Address - Country:US
Practice Address - Phone:602-509-0033
Practice Address - Fax:602-923-8996
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-895175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath