Provider Demographics
NPI:1326542838
Name:DELGADO, JUANITA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:MARIE
Last Name:DELGADO
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 1:114 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2212
Mailing Address - Country:US
Mailing Address - Phone:607-763-2786
Mailing Address - Fax:607-763-2756
Practice Address - Street 1:114 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2212
Practice Address - Country:US
Practice Address - Phone:607-763-2786
Practice Address - Fax:607-763-2756
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY497769163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043510605Medicaid
NYXXX-XX-1451Medicaid