Healthcare Provider Details

I. General information

NPI: 1003223355
Provider Name (Legal Business Name): JESSICA MARY DELCORVO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 400
LANSING MI
48912-1806
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax: 517-364-9605
Mailing address:
  • Phone: 517-364-9650
  • Fax: 517-364-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704264695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: