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General NPI Number Information
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NPI Number | 1659450898
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Entity Type | Individual
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Provider Name | LISA GAYE DALEY APRN, BC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3635 VISTA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2539
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Country | US
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Telephone | 314-577-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2617 IOWA ST
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City | GRANITE CITY
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State | IL
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Zip | 62040-4806
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Country | US
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Telephone | 618-876-7285
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 155148
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License Number State | MO
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