Provider Demographics
NPI:1487241394
Name:DALEY, JUSTINA SUE
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:SUE
Last Name:DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:SUE
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 WOODY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:AL
Mailing Address - Zip Code:35760-9689
Mailing Address - Country:US
Mailing Address - Phone:256-426-9442
Mailing Address - Fax:
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily