Provider Demographics
NPI:1538311832
Name:DELICE, EDNER
Entity Type:Individual
Prefix:
First Name:EDNER
Middle Name:
Last Name:DELICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HEMERWAY STREET
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4845
Mailing Address - Country:US
Mailing Address - Phone:978-686-3505
Mailing Address - Fax:
Practice Address - Street 1:19 HEMERWAY STREET
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4845
Practice Address - Country:US
Practice Address - Phone:978-686-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57792164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse