Provider Demographics
NPI:1639242415
Name:DELANEY, MONICA J (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:DELANEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20095 GILBERT ROAD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2214
Mailing Address - Country:US
Mailing Address - Phone:231-796-5875
Mailing Address - Fax:231-796-6673
Practice Address - Street 1:20095 GILBERT ROAD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2214
Practice Address - Country:US
Practice Address - Phone:231-796-5875
Practice Address - Fax:231-796-6673
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI544353P05Medicare ID - Type Unspecified