Provider Demographics
NPI:1659570562
Name:MIKULSKY, DELSIE SUE
Entity Type:Individual
Prefix:
First Name:DELSIE
Middle Name:SUE
Last Name:MIKULSKY
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 1:14 BARBARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-0014
Mailing Address - Country:US
Mailing Address - Phone:845-297-2421
Mailing Address - Fax:845-297-2421
Practice Address - Street 1:14 BARBARA DRIVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-0014
Practice Address - Country:US
Practice Address - Phone:845-297-2421
Practice Address - Fax:845-297-2421
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228671-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse