Healthcare Provider Details

I. General information

NPI: 1033554233
Provider Name (Legal Business Name): DELTA HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN STREET
DELTA CO
81416
US

IV. Provider business mailing address

1025 MAIN STREET
DELTA CO
81416
US

V. Phone/Fax

Practice location:
  • Phone: 970-964-7740
  • Fax: 970-874-6330
Mailing address:
  • Phone: 970-964-7740
  • Fax: 970-874-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberC-APN 2573
License Number StateCO

VIII. Authorized Official

Name: ALICEMARIE SLAVEN-EMOND
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential: FNP-C
Phone: 970-964-7740