Provider Demographics
NPI:1568715993
Name:DALE, EMILY (CPM, LM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4607
Mailing Address - Country:US
Mailing Address - Phone:928-779-6064
Mailing Address - Fax:928-773-9694
Practice Address - Street 1:20 E CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4607
Practice Address - Country:US
Practice Address - Phone:928-779-6064
Practice Address - Fax:928-773-9694
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12090018176B00000X
AZ177176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife