Basic Information
| Provider Information | |||||||||
| NPI: | 1114984663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALZELL | ||||||||
| FirstName: | DIONNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9525 N BEACH ST STE 405 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762446438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175027411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9525 N BEACH ST STE 405 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175027411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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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 | 363LF0000X | AP117498 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 76248 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 110705 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207T00000X | AP117498 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 203611302 | 05 | TX | MEDICAID | 281353702 | 01 | TX | MEDICAID GROUP EP1 | OTHER | 281353701 | 01 | TX | MEDICAID GROUP TPI | OTHER | 8Y9337 | 01 | TX | BCBS | OTHER |