Provider Demographics
NPI:1619250909
Name:DELLACORT, PATTI JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:JO
Last Name:DELLACORT
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 1:1445 BUNYAN RD
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3201
Mailing Address - Country:US
Mailing Address - Phone:530-251-8183
Mailing Address - Fax:530-251-2668
Practice Address - Street 1:1445 BUNYAN RD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3201
Practice Address - Country:US
Practice Address - Phone:530-251-8183
Practice Address - Fax:530-251-2668
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA778218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse