Provider Demographics
NPI:1700269289
Name:DELO, JACKI L (LFNP-C, CNOR, CRNFA)
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:L
Last Name:DELO
Suffix:
Gender:F
Credentials:LFNP-C, CNOR, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 FALL HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3511
Mailing Address - Country:US
Mailing Address - Phone:540-371-1226
Mailing Address - Fax:540-371-2049
Practice Address - Street 1:1708 FALL HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3511
Practice Address - Country:US
Practice Address - Phone:540-371-1226
Practice Address - Fax:540-371-2049
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001155621163WR0006X
VA0024172709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant