MEDICARE: CORNELIUS ADDUN DALOG II

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	163W00000X	Registered Nurse	1218562	TX

General Provider Information

NPI Number	:	1477495497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELIUS ADDUN DALOG II

Provider Business Mailing Address
First Line	:	2580 COLLIN MCKINNEY PKWY APT 2926
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-5227
Country	:	US
Telephone Number	:	945-333-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 ALLIED DR FL 4
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5348
Country	:	US
Telephone Number	:	469-892-1400
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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