Provider Demographics
NPI:1740826817
Name:DELANCEY, KYLER
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:
Last Name:DELANCEY
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 1:409 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2836
Mailing Address - Country:US
Mailing Address - Phone:307-680-2610
Mailing Address - Fax:
Practice Address - Street 1:409 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2836
Practice Address - Country:US
Practice Address - Phone:307-680-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program