Provider Demographics
NPI:1497096895
Name:DALY, EDYTHE FAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:EDYTHE
Middle Name:FAYE
Last Name:DALY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-3004
Mailing Address - Country:US
Mailing Address - Phone:360-424-1282
Mailing Address - Fax:360-424-1259
Practice Address - Street 1:4469 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-3004
Practice Address - Country:US
Practice Address - Phone:360-424-1282
Practice Address - Fax:360-424-1259
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00117807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse