Provider Demographics
NPI:1285855866
Name:DELIKAT, THERESA KAREN (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:KAREN
Last Name:DELIKAT
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 1:6395E 2000N
Mailing Address - Street 2:P.O.BOX 714
Mailing Address - City:FORT DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84026
Mailing Address - Country:US
Mailing Address - Phone:435-725-6839
Mailing Address - Fax:
Practice Address - Street 1:6822E 1000S
Practice Address - Street 2:
Practice Address - City:FORT DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84026-0160
Practice Address - Country:US
Practice Address - Phone:435-828-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6036243-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health