Healthcare Provider Details

I. General information

NPI: 1407946494
Provider Name (Legal Business Name): PATRICIA W DELACOURT RN, APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ THE HEART STATION
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 COOPER PLZ KELEMAN 404
CAMDEN NJ
08103-1461
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-3090
  • Fax: 856-968-8431
Mailing address:
  • Phone: 856-342-3090
  • Fax: 856-968-8431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNR057029
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNJ000649
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP006250P
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN226094L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: