Healthcare Provider Details

I. General information

NPI: 1669408605
Provider Name (Legal Business Name): PATRICIA DELWICHE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HUGHES ST
CLINTONVILLE WI
54929-1534
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 715-823-5161
  • Fax:
Mailing address:
  • Phone: 920-996-3298
  • Fax: 920-738-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: