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General NPI Number Information
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NPI Number | 1154561587
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Entity Type | Individual
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Provider Name | MICHELLE D DELKETTIE LMP
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Gender | Female
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 2209 ELM ST STE 204
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City | BELLINGHAM
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State | WA
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Zip | 98225-2855
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Country | US
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Telephone | 509-741-0716
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 615
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City | DEMING
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State | WA
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Zip | 98244-0615
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Country | US
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Telephone | 509-741-0716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00025169
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License Number State | WA
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