Healthcare Provider Details

I. General information

NPI: 1740510452
Provider Name (Legal Business Name): DONALD LEE DALY RNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CABALLERO DR SE
ALBUQUERQUE NM
87123-4466
US

IV. Provider business mailing address

1401 CABALLERO DR SE
ALBUQUERQUE NM
87123-4466
US

V. Phone/Fax

Practice location:
  • Phone: 505-539-5642
  • Fax: 505-539-5647
Mailing address:
  • Phone: 505-539-5642
  • Fax: 505-539-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number268036
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number55252
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: