Provider Demographics
NPI:1619677960
Name:DELGADILLO, MARISSA A
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:DELGADILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 PANACA DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4840
Mailing Address - Country:US
Mailing Address - Phone:775-450-8803
Mailing Address - Fax:
Practice Address - Street 1:6629 S VIRGINIA ST STE C
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1161
Practice Address - Country:US
Practice Address - Phone:775-636-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV863521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily