Provider Demographics
NPI:1821809500
Name:FONSECA PANEQUE, DELMIS
Entity type:Individual
Prefix:
First Name:DELMIS
Middle Name:
Last Name:FONSECA PANEQUE
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 1:1404 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6618
Mailing Address - Country:US
Mailing Address - Phone:308-383-5373
Mailing Address - Fax:
Practice Address - Street 1:2015 W 1ST ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5408
Practice Address - Country:US
Practice Address - Phone:308-383-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant