Provider Demographics
NPI:1770819104
Name:DALEY, SEMISE R (NP)
Entity Type:Individual
Prefix:MS
First Name:SEMISE
Middle Name:R
Last Name:DALEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6973 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6342
Mailing Address - Country:US
Mailing Address - Phone:858-279-0925
Mailing Address - Fax:858-279-0377
Practice Address - Street 1:6973 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6342
Practice Address - Country:US
Practice Address - Phone:858-279-0925
Practice Address - Fax:858-279-0377
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003085A363LF0000X
CA829557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200961520Medicaid
IN200961520Medicaid