Healthcare Provider Details

I. General information

NPI: 1023360880
Provider Name (Legal Business Name): DELILAH LUANNE MERGUPE RN, FNP, ENP, SAMFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 12/12/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402
APO AE
09180
US

IV. Provider business mailing address

3415 MARTIN LUTHER KING JR BLVD
SACRAMENTO CA
95817-3648
US

V. Phone/Fax

Practice location:
  • Phone: 916-384-8061
  • Fax:
Mailing address:
  • Phone: 916-737-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: