Provider Demographics
NPI:1104142876
Name:NOWILL, DALE K (RN LICENSE #316156)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:K
Last Name:NOWILL
Suffix:
Gender:F
Credentials:RN LICENSE #316156
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 OLD ORANGEBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-359-1000
Mailing Address - Fax:
Practice Address - Street 1:45 ASHLEY AVE, BUILDING #57
Practice Address - Street 2:MIDDLETOWN MENTAL HEALTH CLINIC
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-343-6686
Practice Address - Fax:845-326-8157
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse