Provider Demographics
NPI:1194186080
Name:DELOREA, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DELOREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34225 N 27TH DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6087
Mailing Address - Country:US
Mailing Address - Phone:602-810-1210
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:34225 N 27TH DR
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6087
Practice Address - Country:US
Practice Address - Phone:602-810-1210
Practice Address - Fax:561-282-3238
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst