Provider Demographics
NPI:1275759326
Name:DALTON, DOUGLAS MARK (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MARK
Last Name:DALTON
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN280045163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health