Doctor Name: | DESIRAE DYAN DELBRIDGE |
NPI Number: | 1407138399 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 5601006127 |
Business Practice Address: | 4154 W Vienna Rd Clio, MI - 484202809 |
Business Phone Number: | 8106871008 |
Business Fax Number: | |
Mailing Address: | 225 E 5th St, Suite 300 FLINT |
State: | MI |
Postal Code: | 485021641 |
Phone Number: | 8104064246 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2011 |
NPI Last Update Date: | 06/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601006127 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |