Provider Demographics
NPI:1114984663
Name:DALZELL, DIONNA M (ARNP)
Entity Type:Individual
Prefix:
First Name:DIONNA
Middle Name:M
Last Name:DALZELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 N BEACH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6438
Mailing Address - Country:US
Mailing Address - Phone:817-502-7411
Mailing Address - Fax:
Practice Address - Street 1:9525 N BEACH ST STE 405
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-502-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117498363LF0000X, 207T00000X
TX76248363LF0000X
NE110705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203611302Medicaid
TX281353702OtherMEDICAID GROUP EP1
TX281353701OtherMEDICAID GROUP TPI
TX8Y9337OtherBCBS
TX203611302Medicaid