Provider Demographics
NPI:1285310938
Name:DELISCA, PATRICK (LPN)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:DELISCA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:CASSANDRE
Other - Middle Name:
Other - Last Name:DELISCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:934 SKIPTON LOOP
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4513
Mailing Address - Country:US
Mailing Address - Phone:516-673-1608
Mailing Address - Fax:
Practice Address - Street 1:934 SKIPTON LOOP
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4513
Practice Address - Country:US
Practice Address - Phone:516-673-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X
OHLPN.168308.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care