Provider Demographics
NPI:1528133196
Name:DALLY, MAUREEN BRIDGID (RN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:BRIDGID
Last Name:DALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80586
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48908-0586
Mailing Address - Country:US
Mailing Address - Phone:517-321-7248
Mailing Address - Fax:517-321-4493
Practice Address - Street 1:6110 W WILLOW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1215
Practice Address - Country:US
Practice Address - Phone:517-321-7248
Practice Address - Fax:517-321-4493
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse