Individual
DALLAS PROCKL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
752 N HIGH POINT RD, MADISON, WI 53717-2236
(608) 824-4000
(608) 824-4938
Mailing address
752 N HIGH POINT RD, MADISON, WI 53717-2236
(608) 824-4000
(608) 824-4938
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
241852
WI
363L00000X
Nurse Practitioner
Primary
15423-30
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
15423
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316531254
—
WI
Enumeration date
02/22/2021
Last updated
10/29/2024
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