Basic Information
| Provider Information | |||||||||
| NPI: | 1538264130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACKS | ||||||||
| FirstName: | DELMA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | A.R.N.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 MAINE ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858428645 | ||||||||
| FaxNumber: | 7858428645 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 MAINE ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858423635 | ||||||||
| FaxNumber: | 7858428645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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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 | 44518 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 100332920A | 05 | KS | MEDICAID |