Provider Demographics
NPI:1578784039
Name:HALE, DANA LEE (APN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEE
Last Name:HALE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8704 S 16TH ST
Mailing Address - Street 2:PO BOX 3571
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72919-0001
Mailing Address - Country:US
Mailing Address - Phone:479-201-8515
Mailing Address - Fax:479-201-8503
Practice Address - Street 1:616 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4700
Practice Address - Country:US
Practice Address - Phone:479-434-3333
Practice Address - Fax:479-434-3535
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS55212Medicare UPIN