Healthcare Provider Details

I. General information

NPI: 1417004052
Provider Name (Legal Business Name): MS. HEIDRUN M. DALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG DARMSTADT UNIT 29500 BOX 31
DARMSTADT HESSEN
APO AE 09175
DE

IV. Provider business mailing address

USAG-HEIDELBERG IMEU-HEI-HRA UNIT 2937
HEIDELBERG BADEN WURTEMBERG
APO AE 09102
DE

V. Phone/Fax

Practice location:
  • Phone: 06151691710
  • Fax: 06151697579
Mailing address:
  • Phone: 06221577475
  • Fax: 06221575265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4106
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: