Provider Demographics
NPI:1992854848
Name:DELI, MARY LYNN (APNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNN
Last Name:DELI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:414-325-3770
Practice Address - Street 1:4131 W LOOMIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2057
Practice Address - Country:US
Practice Address - Phone:414-325-7246
Practice Address - Fax:414-325-3770
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1631-033363LA2200X
WI1631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36053700Medicaid