Provider Demographics
NPI:1013330729
Name:DELSIGNORE, MARIE (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DELSIGNORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:DELSIGNORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 NEW CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9505
Mailing Address - Country:US
Mailing Address - Phone:304-788-9320
Mailing Address - Fax:304-788-9323
Practice Address - Street 1:1234 NEW CREEK HWY
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9505
Practice Address - Country:US
Practice Address - Phone:304-788-9320
Practice Address - Fax:304-788-9323
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV53316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV53316OtherMEDICAL LICENSE