Basic Information
| Provider Information | |||||||||
| NPI: | 1023360880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERGUPE | ||||||||
| FirstName: | DELILAH | ||||||||
| MiddleName: | LUANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3415 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958173648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167375555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3415 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958173648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167375555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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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 | 363LF0000X | 22042 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.