Provider Demographics
NPI:1942468756
Name:DALEY, THERESA ANN (RPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:DALEY
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8608
Mailing Address - Country:US
Mailing Address - Phone:845-227-8021
Mailing Address - Fax:
Practice Address - Street 1:155 JACKSON RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-8608
Practice Address - Country:US
Practice Address - Phone:845-227-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01 997 873Medicaid