Healthcare Provider Details

I. General information

NPI: 1790865483
Provider Name (Legal Business Name): DELORIS ANN KURLANSIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG UNIT 26610
APO AE
09244
DE

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN: CREDENTIALS UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 01149931804
  • Fax: 2256
Mailing address:
  • Phone: 01149931804
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00109682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: