Provider Demographics
NPI:1487418034
Name:DALTON-LOVE, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DALTON-LOVE
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 1:124 WOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PATAGONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85624-6103
Mailing Address - Country:US
Mailing Address - Phone:317-840-1698
Mailing Address - Fax:
Practice Address - Street 1:124 WOOD CANYON RD
Practice Address - Street 2:
Practice Address - City:PATAGONIA
Practice Address - State:AZ
Practice Address - Zip Code:85624-6103
Practice Address - Country:US
Practice Address - Phone:317-840-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health