Healthcare Provider Details

I. General information

NPI: 1699690867
Provider Name (Legal Business Name): MADELINE DALE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 S CULPEPPER CIR
SPRINGFIELD MO
65804-4270
US

IV. Provider business mailing address

911 E MORNINGSIDE ST
SPRINGFIELD MO
65807-3521
US

V. Phone/Fax

Practice location:
  • Phone: 417-536-8217
  • Fax:
Mailing address:
  • Phone: 417-536-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025043114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: