Provider Demographics
NPI:1518912187
Name:ANDERSON, DELINAH M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DELINAH
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DELINAH
Other - Middle Name:M
Other - Last Name:LALONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1111 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3309
Mailing Address - Country:US
Mailing Address - Phone:989-439-1235
Mailing Address - Fax:989-439-1238
Practice Address - Street 1:120 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9780
Practice Address - Country:US
Practice Address - Phone:989-439-1235
Practice Address - Fax:989-266-3269
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004133OtherLICENSE
MI700G210140OtherBC GROUP PIN
MI700G210140OtherBC GROUP PIN
MIQ09580Medicare UPIN
MIOP19250 001Medicare PIN