Basic Information
| Provider Information | |||||||||
| NPI: | 1942378922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELANEY | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7220 S CIMARRON RD STE 270 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029124100 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 S CIMARRON RD STE 270 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029124100 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA707 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1942378922 | 05 | NV | MEDICAID |