Provider Demographics
NPI:1336848324
Name:DALE, STACEY (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-548-3333
Mailing Address - Fax:
Practice Address - Street 1:540 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5352
Practice Address - Country:US
Practice Address - Phone:410-548-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211664363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR211664OtherMARYLAND BOARD OF NURSING