Provider Demographics
NPI:1790864262
Name:DALY, MARIANNE COLEEN (PAC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:COLEEN
Last Name:DALY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:COLEEN
Other - Last Name:HASBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-719-5700
Practice Address - Fax:605-719-5701
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S103777Medicare PIN