Healthcare Provider Details

I. General information

NPI: 1275759326
Provider Name (Legal Business Name): DOUGLAS MARK DALTON R.N., B.S.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15065 PRIMROSE LN
MIDDLEFIELD OH
44062-9022
US

IV. Provider business mailing address

15065 PRIMROSE LN
MIDDLEFIELD OH
44062-9022
US

V. Phone/Fax

Practice location:
  • Phone: 440-632-1598
  • Fax:
Mailing address:
  • Phone: 440-632-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN280045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: