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General NPI Number Information
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NPI Number | 1245602127
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Entity Type | Individual
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Provider Name | JESSICA DALTON RN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 538 COUNTY ROAD 6100
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City | KIRTLAND
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State | NM
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Zip | 87417-9317
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Country | US
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Telephone | 505-598-6114
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Fax | 505-598-9562
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Provider Business Mailing Address
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Address Line | 538 COUNTY ROAD 6100
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City | KIRTLAND
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State | NM
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Zip | 87417-9317
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Country | US
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Telephone | 505-598-6114
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Fax | 505-598-9562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R66047
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License Number State | NM
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