Provider Demographics
NPI:1235556705
Name:DELACRUZ, DELICIA (RN)
Entity Type:Individual
Prefix:
First Name:DELICIA
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 TANAGER PATH
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6282
Mailing Address - Country:US
Mailing Address - Phone:507-345-5960
Mailing Address - Fax:
Practice Address - Street 1:227 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3573
Practice Address - Country:US
Practice Address - Phone:507-345-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 202082-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse