Healthcare Provider Details

I. General information

NPI: 1174976138
Provider Name (Legal Business Name): STEPHANIE LYNN DELKOSKI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S #300
MINNEAPOLIS MN
55454-1455
US

IV. Provider business mailing address

929 PORTLAND AVE APT 1808
MINNEAPOLIS MN
55404-1268
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7111
  • Fax:
Mailing address:
  • Phone: 920-621-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP 4637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: