Provider Demographics
NPI:1679521181
Name:DAILEY, DAN (ANP)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:DAILEY
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 13TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2317
Mailing Address - Country:US
Mailing Address - Phone:701-854-8245
Mailing Address - Fax:
Practice Address - Street 1:10 N RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FT YATES
Practice Address - State:ND
Practice Address - Zip Code:58538
Practice Address - Country:US
Practice Address - Phone:701-854-8245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP53222Medicare UPIN
ND8HZDF00Medicare PIN