Provider Demographics
NPI:1386311017
Name:DALLEY, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:DALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 S BLUFF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5913
Mailing Address - Country:US
Mailing Address - Phone:801-230-9572
Mailing Address - Fax:
Practice Address - Street 1:45 E VINE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7904
Practice Address - Country:US
Practice Address - Phone:801-266-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical