Provider Demographics
NPI:1235633884
Name:DALY, SALLY ANN (LVN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:DALY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17545 KRISTOPHER CIR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-9611
Mailing Address - Country:US
Mailing Address - Phone:903-521-1474
Mailing Address - Fax:
Practice Address - Street 1:17545 KRISTOPHER CIR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-9611
Practice Address - Country:US
Practice Address - Phone:903-521-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126916164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse