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General NPI Number Information
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NPI Number | 1588170443
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Entity Type | Individual
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Provider Name | STACEY JO DELMARK RN
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Gender | Female
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 677 E MAIN ST STE A
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City | CENTREVILLE
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State | MI
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Zip | 49032-8525
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Country | US
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Telephone | 269-467-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 132 S MONROE ST
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City | STURGIS
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State | MI
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Zip | 49091-1729
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Country | US
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Telephone | 269-221-0681
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704330246
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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