Healthcare Provider Details

I. General information

NPI: 1033103858
Provider Name (Legal Business Name): DALE HARRELL ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SOUTH 7TH STREET BLDG 700/700A 78 MDG/CC
ROBINS AFB GA
31098
US

IV. Provider business mailing address

655 SOUTH 7TH STREET BLDG 700/700A 78 MDG/CC
ROBINS AFB GA
31098
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7997
  • Fax:
Mailing address:
  • Phone: 478-327-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3253869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: