Individual
DIONNA M DALZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
9525 N BEACH ST STE 405, FORT WORTH, TX 76244
(817) 502-7411
Mailing address
9525 N BEACH ST STE 405, FORT WORTH, TX 76244-6438
(817) 502-7411
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
AP117498
TX
363LF0000X
Family Nurse Practitioner
110705
NE
363LF0000X
Family Nurse Practitioner
76248
TX
363LF0000X
Family Nurse Practitioner
AP117498
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203611302
—
TX
01
—
281353701
MEDICAID GROUP TPI
TX
01
—
281353702
MEDICAID GROUP EP1
TX
01
—
8Y9337
BCBS
TX
Enumeration date
04/27/2006
Last updated
03/06/2019
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