Provider Demographics
NPI:1316096886
Name:FLUEGEL, DALE ROBERT (FNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
Last Name:FLUEGEL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:ROBERT
Other - Last Name:FLUEGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3383
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:733 VOLVO PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1609
Practice Address - Country:US
Practice Address - Phone:757-321-3383
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003442-1111N00000X
VA0024168215363L00000X, 363LF0000X
NYF335597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC03442-3BOtherWORKER'S COMPENSATION NO.
NYT-26765Medicare UPIN
NYT-26765Medicare UPIN