Provider Demographics
NPI:1720496300
Name:DELLINGER, DALE (RN, CFNP)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:DELLINGER
Suffix:
Gender:M
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 POLO PARK CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8348
Mailing Address - Country:US
Mailing Address - Phone:254-666-2366
Mailing Address - Fax:
Practice Address - Street 1:1401 STATE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76599-0001
Practice Address - Country:US
Practice Address - Phone:254-865-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist