Provider Demographics
NPI:1114186723
Name:DALTON, ELIZABETH MARY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:DALTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:421 W STATE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2626
Mailing Address - Country:US
Mailing Address - Phone:610-566-1775
Mailing Address - Fax:610-566-1775
Practice Address - Street 1:4508 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3608
Practice Address - Country:US
Practice Address - Phone:215-573-7200
Practice Address - Fax:215-746-2149
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP007691363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology