Provider Demographics
NPI:1689735466
Name:DELANEY, CATHERINE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
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:PO BOX 3469
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-3469
Mailing Address - Country:US
Mailing Address - Phone:505-507-2509
Mailing Address - Fax:505-836-1117
Practice Address - Street 1:111 SANDOVAL RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7320
Practice Address - Country:US
Practice Address - Phone:505-565-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-PA11363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R7224Medicaid