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General NPI Number Information
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NPI Number | 1699791707
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Entity Type | Individual
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Provider Name | DELYTHE JEAN KRACKE NP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 1075 TOLLAND TPKE
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City | MANCHESTER
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State | CT
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Zip | 06042-1609
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Country | US
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Telephone | 860-647-4796
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Fax |
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Provider Business Mailing Address
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Address Line | 35 VINETTA DR
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City | VERNON
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State | CT
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Zip | 06066-4011
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Country | US
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Telephone | 860-872-3004
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 001610
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License Number State | CT
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