Provider Demographics
NPI:1588817712
Name:CHILDRESS, DELPHINE ANITA (RN)
Entity Type:Individual
Prefix:MS
First Name:DELPHINE
Middle Name:ANITA
Last Name:CHILDRESS
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 1:2111 TEMPLE DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017
Mailing Address - Country:US
Mailing Address - Phone:540-345-6015
Mailing Address - Fax:
Practice Address - Street 1:2111 TEMPLE DRIVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017
Practice Address - Country:US
Practice Address - Phone:540-345-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001123990163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse