Provider Demographics
NPI:1821292376
Name:DAHLBERG, LAURIE SUZANNE (RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:SUZANNE
Last Name:DAHLBERG
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:7720 N FRESNO ST
Mailing Address - Street 2:#104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2407
Mailing Address - Country:US
Mailing Address - Phone:559-438-1802
Mailing Address - Fax:559-438-1531
Practice Address - Street 1:7720 N FRESNO ST
Practice Address - Street 2:#104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2407
Practice Address - Country:US
Practice Address - Phone:559-438-1802
Practice Address - Fax:559-438-1531
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA524692363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics