Provider Demographics
NPI:1730467895
Name:DALEY, MARILYN C
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:C
Last Name:DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:DALEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:17102 EAGLE HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:AQUASCO
Mailing Address - State:MD
Mailing Address - Zip Code:20608-9566
Mailing Address - Country:US
Mailing Address - Phone:301-300-4570
Mailing Address - Fax:
Practice Address - Street 1:17102 EAGLE HARBOR RD
Practice Address - Street 2:
Practice Address - City:AQUASCO
Practice Address - State:MD
Practice Address - Zip Code:20608-9566
Practice Address - Country:US
Practice Address - Phone:301-300-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO83660163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse