Provider Demographics
NPI:1871122325
Name:DALEY, JAMIE M
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:M
Last Name:DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 LAKESIDE DR APT E
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-8865
Mailing Address - Country:US
Mailing Address - Phone:317-371-4625
Mailing Address - Fax:
Practice Address - Street 1:1678 FRY RD STE D
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1176
Practice Address - Country:US
Practice Address - Phone:317-865-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program