Healthcare Provider Details

I. General information

NPI: 1851349831
Provider Name (Legal Business Name): MICHELLE DELGADO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE POWERS CRNA

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

IV. Provider business mailing address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-1521
  • Fax: 815-748-8395
Mailing address:
  • Phone: 815-756-1521
  • Fax: 815-748-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209005600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: