Provider Demographics
NPI:1942957386
Name:DELGADO, KENISHA
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:
Last Name:DELGADO
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 1:3842 KENNETT PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2302
Mailing Address - Country:US
Mailing Address - Phone:302-290-6057
Mailing Address - Fax:
Practice Address - Street 1:3842 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2302
Practice Address - Country:US
Practice Address - Phone:302-290-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0010054164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000000Medicaid