Provider Demographics
NPI:1427327741
Name:DALILI, DAWN M (ND)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:DALILI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 STOCKYARD RD STE A5
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1542
Mailing Address - Country:US
Mailing Address - Phone:405-540-4256
Mailing Address - Fax:833-210-8436
Practice Address - Street 1:2825 STOCKYARD RD STE A5
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1542
Practice Address - Country:US
Practice Address - Phone:405-540-4256
Practice Address - Fax:833-210-8436
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1247175F00000X
MTAHC-NAT-LIC-1442175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath