Provider Demographics
NPI:1013548262
Name:ALEX, DALLY
Entity Type:Individual
Prefix:
First Name:DALLY
Middle Name:
Last Name:ALEX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DALLY
Other - Middle Name:
Other - Last Name:ALEX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:14022 JUMP DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6122
Mailing Address - Country:US
Mailing Address - Phone:484-674-5487
Mailing Address - Fax:
Practice Address - Street 1:4954 NORTH PALMER RD
Practice Address - Street 2:AMERICA BUILDING 19, THIRD FLOOR
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-4330
Practice Address - Country:US
Practice Address - Phone:301-319-2900
Practice Address - Fax:301-319-2901
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208579363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily