Provider Demographics
NPI:1023193570
Name:DALE, VERONICA IRENE (RN, NP, CNS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:IRENE
Last Name:DALE
Suffix:
Gender:F
Credentials:RN, NP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 OWENSMOUTH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4255
Mailing Address - Country:US
Mailing Address - Phone:818-610-6700
Mailing Address - Fax:
Practice Address - Street 1:6800 OWENSMOUTH AVE STE 160
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4255
Practice Address - Country:US
Practice Address - Phone:818-610-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN402501163WP0808X
CA1026364SP0809X
CA15142363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult