Provider Demographics
NPI:1932466034
Name:DELZER, ASHLEY LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LOUISE
Last Name:DELZER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DELZER
Other - Last Name:HRCKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1135 W UNIVERSITY DR STE 450
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1871
Mailing Address - Country:US
Mailing Address - Phone:248-659-0196
Mailing Address - Fax:248-650-2400
Practice Address - Street 1:1135 W UNIVERSITY DR STE 450
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-659-0196
Practice Address - Fax:248-650-2400
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001380A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932466034Medicaid