Provider Demographics
NPI:1306088398
Name:LAKIA, DELORIS MITCHUSON (CNP)
Entity type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:MITCHUSON
Last Name:LAKIA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:DELORIS
Other - Middle Name:
Other - Last Name:MITCHUSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3000 ARLINGTON AVE
Mailing Address - Street 2:UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE MAILSTOP 1186
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-6858
Mailing Address - Fax:419-383-6243
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:RUPPERT HEALTH CENTER ENDOCRINOLOGY
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-6612
Practice Address - Fax:419-383-3336
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170371163W00000X
OH10446363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse