Healthcare Provider Details

I. General information

NPI: 1740431642
Provider Name (Legal Business Name): PAMELA SUE DALSIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 S 6TH STREET RD SUITE 2400
SPRINGFIELD IL
62703-5735
US

IV. Provider business mailing address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7700
  • Fax: 217-757-7799
Mailing address:
  • Phone: 217-525-1064
  • Fax: 217-525-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041-225210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: