Healthcare Provider Details

I. General information

NPI: 1245575133
Provider Name (Legal Business Name): DELELLIS YORK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5730 PACKARD AVE SUITE 100
MARYSVILLE CA
95901-7118
US

IV. Provider business mailing address

5730 PACKARD AVE SUITE 100
MARYSVILLE CA
95901-7118
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-6311
  • Fax: 530-749-6397
Mailing address:
  • Phone: 530-749-6311
  • Fax: 530-749-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number638700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: