Provider Demographics
NPI:1649240458
Name:DELESHA, KAREN S (WHCNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:DELESHA
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 MOURNING DOVE PATH
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6212
Mailing Address - Country:US
Mailing Address - Phone:507-388-5513
Mailing Address - Fax:
Practice Address - Street 1:310 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5287
Practice Address - Country:US
Practice Address - Phone:507-387-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR049049-0363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
115655OtherUCARE
MN441526400Medicaid
07-00159OtherMEDICA
HP20499OtherHEALTH PARTNERS
1068174OtherPREFERRED ONE
1068174OtherAMERICA'S PPO (ARAZ)
MN68G17DEOtherBCBS MN
07-00159OtherMEDICA
MN68G17DEOtherBCBS MN