Healthcare Provider Details

I. General information

NPI: 1700269289
Provider Name (Legal Business Name): JACKI L DELO LFNP-C, CNOR, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 FALL HILL AVE SUITE 100
FREDERICKSBURG VA
22401-3511
US

IV. Provider business mailing address

1708 FALL HILL AVE SUITE 100
FREDERICKSBURG VA
22401-3511
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-1226
  • Fax: 540-371-2049
Mailing address:
  • Phone: 540-371-1226
  • Fax: 540-371-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0001155621
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: