Individual
KELLY M DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4420 76TH ST NE, MARYSVILLE, WA 98270-3726
(360) 651-7493
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30005577
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018658
—
WA
Enumeration date
11/08/2006
Last updated
12/11/2012
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