Basic Information
| Provider Information | |||||||||
| NPI: | 1508910985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELZER | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 631 SAINT ANNE ST STE 102 | ||||||||
| Address2: | PO BOX 2760 | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577014693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053431333 | ||||||||
| FaxNumber: | 6053436017 | ||||||||
| Practice Location | |||||||||
| Address1: | 2908 5TH ST | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057555228 | ||||||||
| FaxNumber: | 6057194768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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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 | 363L00000X | CP000392 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | R026231 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.