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General NPI Number Information
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NPI Number | 1801088653
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Entity Type | Individual
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Provider Name | DELILAH POLLAN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 1083 MALLARD POINT RD
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City | BATESVILLE
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State | MS
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Zip | 38606-3976
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Country | US
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Telephone | 662-902-1924
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Fax | 662-563-1039
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Provider Business Mailing Address
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Address Line | 777 ISLE OF CAPRI PKWY CAPRI WELLNESS CLINIC
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City | LULA
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State | MS
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Zip | 38644
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Country | US
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Telephone | 662-902-1924
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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 | R568325
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License Number State | MS
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