Provider Demographics
NPI:1295821627
Name:BARDALES, DELORES ELLEN (MSN, APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:ELLEN
Last Name:BARDALES
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 PLEASANTVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3325
Mailing Address - Country:US
Mailing Address - Phone:740-475-0501
Mailing Address - Fax:740-653-7512
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-653-7511
Practice Address - Fax:740-653-7512
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09079-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750394Medicaid