Healthcare Provider Details

I. General information

NPI: 1003662479
Provider Name (Legal Business Name): LEA M DALEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 WUNNENBERG WAY
WEST CHESTER OH
45069-4863
US

IV. Provider business mailing address

110 HANFORD LN
MONROE OH
45050-1864
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-6166
  • Fax:
Mailing address:
  • Phone: 917-282-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0038195
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.438218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: