MEDICARE: GWEN E DELK APRN, FNP

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	363LF0000X	Family Nurse Practitioner	AP125282	TX
2	363LF0000X	Family Nurse Practitioner	RN212354	GA

General Provider Information

NPI Number	:	1821400581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN E DELK APRN, FNP

Provider Business Mailing Address
First Line	:	407 KENT ST
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79701-5858
Country	:	US
Telephone Number	:	432-687-2273
Fax Number	:	512-206-0696

Provider Business Practice Location Address
First Line	:	3304 LAUREL CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-5721
Country	:	US
Telephone Number	:	432-687-2273
Fax Number	:	512-206-0696

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

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	05/28/2014

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