Provider Demographics
NPI:1043478829
Name:DELELLIS, KEMBERLY (ND)
Entity Type:Individual
Prefix:DR
First Name:KEMBERLY
Middle Name:
Last Name:DELELLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:KEMBY
Other - Middle Name:
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6622
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-6622
Mailing Address - Country:US
Mailing Address - Phone:808-333-0530
Mailing Address - Fax:
Practice Address - Street 1:826 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4807
Practice Address - Country:US
Practice Address - Phone:530-885-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND164175F00000X
WANT 60134126175F00000X
HIND-226175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath