Individual
MARY DAHLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1000 WALTERS ST, LAKE CHARLES, LA 70607-4647
(337) 475-8100
Mailing address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 475-8100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
081161
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022799
—
LA
Enumeration date
04/24/2007
Last updated
12/27/2016
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