Provider Demographics
NPI:1396089587
Name:DALGLEISH, WILINDA CARLSON (APRN)
Entity type:Individual
Prefix:MS
First Name:WILINDA
Middle Name:CARLSON
Last Name:DALGLEISH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W HALE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8439
Mailing Address - Country:US
Mailing Address - Phone:337-433-9177
Mailing Address - Fax:337-433-9173
Practice Address - Street 1:324 W HALE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8439
Practice Address - Country:US
Practice Address - Phone:337-433-9177
Practice Address - Fax:337-433-9173
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131574-7062363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2342908Medicaid