Provider Demographics
NPI:1366633588
Name:DALZIEL, BARBARA J
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:DALZIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:WOODERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:17200 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3355
Mailing Address - Country:US
Mailing Address - Phone:586-859-7455
Mailing Address - Fax:586-859-7454
Practice Address - Street 1:17200 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3355
Practice Address - Country:US
Practice Address - Phone:586-859-7455
Practice Address - Fax:586-859-7454
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704174588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily