Provider Demographics
NPI:1144494832
Name:DALTON, DENNAE (PA-C)
Entity type:Individual
Prefix:
First Name:DENNAE
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DENNAE
Other - Middle Name:
Other - Last Name:NOBLITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:802-909-2053
Mailing Address - Fax:
Practice Address - Street 1:6639 WHITESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7622
Practice Address - Country:US
Practice Address - Phone:317-732-8980
Practice Address - Fax:317-732-8979
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000725A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00478874OtherRAILROAD MEDICARE
INQ35280Medicare UPIN
IN187490GMedicare PIN