Provider Demographics
NPI:1780239483
Name:DUCAR, DALLAS MICHELLE (MSN, APRN, CNL, FAAN)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:MICHELLE
Last Name:DUCAR
Suffix:
Gender:F
Credentials:MSN, APRN, CNL, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60538
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-0538
Mailing Address - Country:US
Mailing Address - Phone:413-341-9400
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST FL HALL4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-643-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2333294363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2333294OtherMASSACHUSETTS BOARD OF REGISTRATION NURSING