Provider Demographics
NPI:1306527015
Name:DELVOYE, JESSICA ELEAN (APNP, FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELEAN
Last Name:DELVOYE
Suffix:
Gender:F
Credentials:APNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 FORESTVILLE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1712
Mailing Address - Country:US
Mailing Address - Phone:920-660-8782
Mailing Address - Fax:
Practice Address - Street 1:2506 FORESTVILLE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1712
Practice Address - Country:US
Practice Address - Phone:920-660-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14282363L00000X
WI14282-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100266825Medicaid