Provider Demographics
NPI:1164555991
Name:DALY, JEANETTE (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:MISS
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:CAPKOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:802 OLMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-580-0848
Mailing Address - Fax:
Practice Address - Street 1:3601 ODONNELL STR
Practice Address - Street 2:ELDER HEALTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-864-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR123444363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health