Provider Demographics
NPI:1598964249
Name:DELANCEY, JULIE R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:R
Last Name:DELANCEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14009 LEATHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SENECAVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43780-9014
Mailing Address - Country:US
Mailing Address - Phone:740-685-8942
Mailing Address - Fax:
Practice Address - Street 1:14009 LEATHERWOOD CIR
Practice Address - Street 2:
Practice Address - City:SENECAVILLE
Practice Address - State:OH
Practice Address - Zip Code:43780-9014
Practice Address - Country:US
Practice Address - Phone:740-685-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN090591164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2273427Medicaid