MEDICARE: MS. DEBRA MAY DELATTE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374T00000X	Religious Nonmedical Nursing Personnel	6484	AK

General Provider Information

NPI Number	:	1770798241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA MAY DELATTE LPN

Provider Business Mailing Address
First Line	:	PO BOX 181
Second Line	:
City	:	KOTZEBUE
State	:	AK
Zip	:	99752-0181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 N LAKE DR
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3305
Country	:	US
Telephone Number	:	907-442-3349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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