Provider Demographics
NPI:1689601205
Name:DELANCEY, PAMELA L (MS, ATC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:DELANCEY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 PARK AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2186
Mailing Address - Country:US
Mailing Address - Phone:218-766-8082
Mailing Address - Fax:
Practice Address - Street 1:1500 BIRCHMONT DR NE #29
Practice Address - Street 2:PE COMPLEX
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2699
Practice Address - Country:US
Practice Address - Phone:218-755-2769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer