Healthcare Provider Details

I. General information

NPI: 1609736982
Provider Name (Legal Business Name): DELANEY ELIZABETH DETERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELANEY ELIZABETH RUDD PA-C

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 KENWOOD RD
CINCINNATI OH
45243-2327
US

IV. Provider business mailing address

7656 TOURS LN APT B
CENTERVILLE OH
45459-5370
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: