Healthcare Provider Details

I. General information

NPI: 1588321327
Provider Name (Legal Business Name): EMMA MARIE DALEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 PINE ST
FRANKLIN WV
26807
US

IV. Provider business mailing address

PO BOX 100
FRANKLIN WV
26807-0100
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2355
  • Fax:
Mailing address:
  • Phone: 304-358-2355
  • Fax: 855-332-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111162
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: