Provider Demographics
NPI:1669053476
Name:DELGADO, BERENICE
Entity type:Individual
Prefix:
First Name:BERENICE
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 1:3707 7TH ST W APT 203
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4263
Mailing Address - Country:US
Mailing Address - Phone:701-609-4824
Mailing Address - Fax:
Practice Address - Street 1:3707 7TH ST W APT 203
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4263
Practice Address - Country:US
Practice Address - Phone:701-609-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant