Healthcare Provider Details

I. General information

NPI: 1922929744
Provider Name (Legal Business Name): MA GRACE RAQUEL DELZELL AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 S 73RD CT APT 212
PAPILLION NE
68046-4880
US

IV. Provider business mailing address

11975 S 73RD CT APT 212
PAPILLION NE
68046-4880
US

V. Phone/Fax

Practice location:
  • Phone: 712-635-6764
  • Fax:
Mailing address:
  • Phone: 712-635-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number117073
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: