Provider Demographics
NPI:1548631336
Name:DAHLGREN, SHIRLEY JEAN (RN)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BROADWAY
Mailing Address - Street 2:BOX 677
Mailing Address - City:VERPLANCK
Mailing Address - State:NY
Mailing Address - Zip Code:10596-7707
Mailing Address - Country:US
Mailing Address - Phone:914-582-3744
Mailing Address - Fax:
Practice Address - Street 1:152 BROADWAY
Practice Address - Street 2:BOX 677
Practice Address - City:VERPLANCK
Practice Address - State:NY
Practice Address - Zip Code:10596-7707
Practice Address - Country:US
Practice Address - Phone:914-582-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659005163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health