MEDICARE: DIONNA M DALZELL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP117498	TX
2	363LF0000X	Family Nurse Practitioner	76248	TX
3	363LF0000X	Family Nurse Practitioner	110705	NE
4	207T00000X	Neurological Surgery Physician	AP117498	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8Y9337	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1114984663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONNA M DALZELL ARNP

Provider Business Mailing Address
First Line	:	9525 N BEACH ST STE 405
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6438
Country	:	US
Telephone Number	:	817-502-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 N BEACH ST STE 405
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244
Country	:	US
Telephone Number	:	817-502-7411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	03/06/2019

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