Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2010025834 | MO |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 53-75150-102 | KS |
NPI | 1043524499 |
---|---|
Provider Name | M Danielle Delozier |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 27/07/2010 |