Provider Demographics
NPI:1407903339
Name:DELEWSKI, KATHLEEN ALICIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ALICIA
Last Name:DELEWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHERMAN ST
Mailing Address - Street 2:APARTMENT #1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2204
Mailing Address - Country:US
Mailing Address - Phone:207-773-1131
Mailing Address - Fax:
Practice Address - Street 1:6 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2917
Practice Address - Country:US
Practice Address - Phone:207-290-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical