Provider Demographics
NPI:1407933047
Name:DALE, JUANITA R (PHD, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:R
Last Name:DALE
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Gender:F
Credentials:PHD, RN, CPNP
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Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:CENTER FOR PEDIATRIC NEUROLOGY - F5400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-2768
Mailing Address - Fax:214-456-6898
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:CENTER FOR PEDIATRIC NEUROLOGY - F5400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-2768
Practice Address - Fax:214-456-6898
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-12-16
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Provider Licenses
StateLicense IDTaxonomies
TX226586363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics