Healthcare Provider Details

I. General information

NPI: 1063493666
Provider Name (Legal Business Name): DELROSE D JONES ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 THEATER RD
ONALASKA WI
54650-8679
US

IV. Provider business mailing address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-5702
  • Fax: 608-392-5789
Mailing address:
  • Phone: 608-392-4718
  • Fax: 608-392-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number83716
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number83716
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number666033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: