Provider Demographics
NPI:1912597535
Name:DALTON, LINDA DIANA (MS APRN AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANA
Last Name:DALTON
Suffix:
Gender:F
Credentials:MS APRN AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WELCH LANE
Mailing Address - Street 2:
Mailing Address - City:EAST BERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12059-2215
Mailing Address - Country:US
Mailing Address - Phone:514-329-1856
Mailing Address - Fax:
Practice Address - Street 1:1072 TROY SCHENECLADY ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1019
Practice Address - Country:US
Practice Address - Phone:518-786-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309928-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health