Provider Demographics
NPI:1629742143
Name:DALY, TERESA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
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 1:2685 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6861
Mailing Address - Country:US
Mailing Address - Phone:843-529-3130
Mailing Address - Fax:843-566-1838
Practice Address - Street 1:2685 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6861
Practice Address - Country:US
Practice Address - Phone:843-529-3130
Practice Address - Fax:843-566-1838
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201657163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse