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General NPI Number Information
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NPI Number | 1477176600
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Entity Type | Individual
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Provider Name | DALLAS LOUIS STALEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2525 CHARLESTON RD STE 104
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94043-1636
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Country | US
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Telephone | 262-893-2045
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | COLBERT
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State | GA
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Zip | 30628-0459
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Country | US
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Telephone |
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN250305
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License Number State | GA
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