Provider Demographics
NPI:1154805893
Name:DALGORD, RHIAN E (NP)
Entity type:Individual
Prefix:
First Name:RHIAN
Middle Name:E
Last Name:DALGORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 LUDINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4213
Mailing Address - Country:US
Mailing Address - Phone:906-789-4414
Mailing Address - Fax:906-789-4406
Practice Address - Street 1:3409 LUDINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4213
Practice Address - Country:US
Practice Address - Phone:906-789-4414
Practice Address - Fax:906-789-4406
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704306610OtherNURSE PRACTITIONER