Basic Information
| Provider Information | |||||||||
| NPI: | 1104142876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOWILL | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | R.N. LICENSE #316156 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 OLD ORANGEBURG ROAD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 ASHLEY AVE, BUILDING #57 | ||||||||
| Address2: | MIDDLETOWN MENTAL HEALTH CLINIC | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453436686 | ||||||||
| FaxNumber: | 8453268157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 04/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 316156 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.