Provider Demographics
NPI:1710317813
Name:DALTON, DONNA MAE (CNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE
Last Name:DALTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLINIC #3301
Mailing Address - Street 2:28100 CHAGRIN BLVD
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4260
Mailing Address - Country:US
Mailing Address - Phone:216-831-1466
Mailing Address - Fax:
Practice Address - Street 1:CLINIC #3301
Practice Address - Street 2:28100 CHAGRIN BLVD
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4412
Practice Address - Country:US
Practice Address - Phone:216-831-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15392363LF0000X
OHAPRN.CNP.15392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty