Provider Demographics
NPI:1881424281
Name:INMAN, DALACESOPHIEA MAGDALANNA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DALACESOPHIEA
Middle Name:MAGDALANNA
Last Name:INMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LOCH CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9181
Mailing Address - Country:US
Mailing Address - Phone:252-624-4003
Mailing Address - Fax:
Practice Address - Street 1:624 S FAYETTEVILLE ST STE D
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6582
Practice Address - Country:US
Practice Address - Phone:336-257-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC336175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse