Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 041445032 | IL |
N | 363LA2100X | Nurse Practitioner - Acute Care | 209019954 | IL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71011454A | IN |
NPI | 1053966606 |
---|---|
Provider Name | Jessica Rae Delgado |
First Address | Detroit, MI 48278-1076 |
Second Address | Orland Park, IL 60462-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2019 |
Last Update Date | 14/02/2022 |