Provider Demographics
NPI:1285320333
Name:DALLEY, MELINDA C (FNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:C
Last Name:DALLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HIGHWAY 8 S
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-9502
Mailing Address - Country:US
Mailing Address - Phone:985-956-6696
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BISON
Practice Address - State:SD
Practice Address - Zip Code:57620-7133
Practice Address - Country:US
Practice Address - Phone:605-244-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2022009825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily