Provider Demographics
NPI:1629081393
Name:DELATE, PATRICIA M (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:DELATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E END RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7201
Mailing Address - Country:US
Mailing Address - Phone:907-226-2228
Mailing Address - Fax:907-262-2230
Practice Address - Street 1:880 E END RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7201
Practice Address - Country:US
Practice Address - Phone:907-226-2228
Practice Address - Fax:907-226-2230
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK841208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKP98110Medicare UPIN
AK8HD729Medicare ID - Type UnspecifiedMEDICARE ID