Provider Demographics
NPI:1457682973
Name:DALEY, DONALD J JR (NP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:DALEY
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W227N6103 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3969
Mailing Address - Country:US
Mailing Address - Phone:414-566-8100
Mailing Address - Fax:414-566-8038
Practice Address - Street 1:W227N6103 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3969
Practice Address - Country:US
Practice Address - Phone:414-566-8100
Practice Address - Fax:414-566-8038
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3855-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily