Provider Demographics
NPI:1669644993
Name:VLADIC, DALE (CRNFA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:VLADIC
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 RANGER ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1822
Mailing Address - Country:US
Mailing Address - Phone:708-790-7333
Mailing Address - Fax:
Practice Address - Street 1:665 RANGER ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1822
Practice Address - Country:US
Practice Address - Phone:708-790-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704423873163WR0006X
FL2560202163WR0006X
CARN95231143163WR0006X
IL258819163WR0006X
WI198661-30163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant