Provider Demographics
NPI:1184646135
Name:DALTON, GAYE MARIE (LPN, BS)
Entity Type:Individual
Prefix:MRS
First Name:GAYE
Middle Name:MARIE
Last Name:DALTON
Suffix:
Gender:F
Credentials:LPN, BS
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:G
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN, BS
Mailing Address - Street 1:15065 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9022
Mailing Address - Country:US
Mailing Address - Phone:440-632-1598
Mailing Address - Fax:
Practice Address - Street 1:15065 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9022
Practice Address - Country:US
Practice Address - Phone:440-632-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 073694164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse