1174843106 NPI number — NANCY B DELANEY PH.D.

Table of content: NANCY B DELANEY PH.D. (NPI 1174843106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174843106 NPI number — NANCY B DELANEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELANEY
Provider First Name:
NANCY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174843106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
377 MDG/SGOW
Provider Second Line Business Mailing Address:
2050A SECOND STREET SE, KIRTLAND AFB
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87117-5522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-846-4511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SOW MEDICAL GROUP
Provider Second Line Business Practice Location Address:
113 LIELMANIS AVE.
Provider Business Practice Location Address City Name:
HURLBURT FIELD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-884-2301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  129719 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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