Provider Demographics
NPI:1508910985
Name:DELZER, MICHELE M (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:DELZER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 SAINT ANNE ST STE 102
Mailing Address - Street 2:PO BOX 2760
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4693
Mailing Address - Country:US
Mailing Address - Phone:605-343-1333
Mailing Address - Fax:605-343-6017
Practice Address - Street 1:2908 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7317
Practice Address - Country:US
Practice Address - Phone:605-755-5228
Practice Address - Fax:605-719-4768
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000392363L00000X
SDR026231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S103586Medicare PIN