Individual
AMELIA B DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, RCS PROVIDER ENROLLMENT, MUNCIE, IN 47303-4988
(765) 254-4009
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10001854A
IN
363AM0700X
Medical Physician Assistant
Primary
10001854A
IN
Other
Enumeration date
07/10/2015
Last updated
02/04/2021
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