Provider Demographics
NPI:1336271071
Name:DALTON, ALICE LOUISE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LOUISE
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:L
Other - Last Name:ISBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8182
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:215 HEDRICK DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-623-5301
Practice Address - Fax:423-625-0808
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator