=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649366402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE DELKS LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 01/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 WHITMORE RD 401
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-4048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-739-4239
-----------------------------------------------------
Fax | 313-842-9608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16183 PRINCETON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48221-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-739-4239
-----------------------------------------------------
Fax | 313-864-2154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 4703090607
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------