Provider Demographics
NPI:1184964330
Name:DELUCA, MYRA JESSICA (CNM)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:JESSICA
Last Name:DELUCA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-845-1621
Mailing Address - Fax:717-854-6939
Practice Address - Street 1:1693 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4609
Practice Address - Country:US
Practice Address - Phone:717-845-1621
Practice Address - Fax:717-854-6939
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010296367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife