Healthcare Provider Details

I. General information

NPI: 1194870147
Provider Name (Legal Business Name): SHIRLEY WERNER DALY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 98TH ST
BLOOMINGTON MN
55420-4773
US

IV. Provider business mailing address

5128 OLIVER AVE S
MINNEAPOLIS MN
55419-1033
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0793867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: