Provider Demographics
NPI:1871689257
Name:DELVECCHIO, ANGELA (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:CADILLAC FAMILY PRACTICE
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1637
Mailing Address - Country:US
Mailing Address - Phone:207-288-5119
Mailing Address - Fax:207-288-8449
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:CADILLAC FAMILY PRACTICE
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1637
Practice Address - Country:US
Practice Address - Phone:207-288-5119
Practice Address - Fax:207-288-8449
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER041588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERO41588OtherLICENSE
MENP422702Medicare PIN