Healthcare Provider Details

I. General information

NPI: 1225749757
Provider Name (Legal Business Name): MISS CHEYANN DELANEY DAGNALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 HOLLAND AVE
PORT HURON MI
48060-1513
US

IV. Provider business mailing address

304 S MAIN ST
YALE MI
48097-3320
US

V. Phone/Fax

Practice location:
  • Phone: 586-556-0140
  • Fax:
Mailing address:
  • Phone: 810-434-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: