Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | COA.12532-NP | OH |
NPI | 1003195546 |
---|---|
Provider Name | Virginia Renee Daley |
First Address | Salem, OH 44460-2236 |
Second Address | Warren, OH 44483-6156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0060422 | (05) | OH |