Healthcare Provider Details

I. General information

NPI: 1417946492
Provider Name (Legal Business Name): KATHRYN MARIE DALY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 WATERTOWN RD
WAUKESHA WI
53186-1871
US

IV. Provider business mailing address

4640 N WOODBURN ST
WHITEFISH BAY WI
53211-1124
US

V. Phone/Fax

Practice location:
  • Phone: 262-798-1910
  • Fax: 262-798-8660
Mailing address:
  • Phone: 414-332-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number56209-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: