Basic Information
| Provider Information | |||||||||
| NPI: | 1396089587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALGLEISH | ||||||||
| FirstName: | WILINDA | ||||||||
| MiddleName: | CARLSON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 W HALE ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374339177 | ||||||||
| FaxNumber: | 3374339173 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 W HALE ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374339177 | ||||||||
| FaxNumber: | 3374339173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2012 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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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 | 363LP0808X | 131574-7062 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2342908 | 05 | LA | MEDICAID |