Provider Demographics
NPI:1558477497
Name:DALY, CAROL L (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:DALY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1840 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2808
Mailing Address - Country:US
Mailing Address - Phone:540-536-8000
Mailing Address - Fax:540-536-7681
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7681
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165736367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007263Medicaid
VA011373W68Medicare ID - Type Unspecified