Provider Demographics
NPI:1720742943
Name:DAHL, DENISE CORENE (RN, CCM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:CORENE
Last Name:DAHL
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 VIA UNIDOS
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3552
Mailing Address - Country:US
Mailing Address - Phone:760-685-5239
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:442-242-1866
Practice Address - Fax:760-725-1515
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530250163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
00109002OtherCOMMISSION OF CASE MANAGER CERTIFICATION
CA530250OtherCA BOARD OF REGISTERED NURSES