Provider Demographics
NPI:1649354069
Name:DELANEY, MARJORIE LEE (NP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:LEE
Last Name:DELANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27650 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3845
Mailing Address - Country:US
Mailing Address - Phone:630-225-2663
Mailing Address - Fax:630-225-2399
Practice Address - Street 1:27650 FERRY RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3845
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:630-225-2399
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01173391OtherMEDICARE RR (INDIVIDUAL)
IL206147OtherMEDICARE PTAN (GROUP)
ILCA4748OtherMEDICARE RR (GROUP)
IL206147162OtherMEDICARE PTAN (INDIVIDUAL)
ILP00288984OtherRR MEDICARE
ILP01173391OtherMEDICARE RR (INDIVIDUAL)
ILP00288984OtherRR MEDICARE