Provider Demographics
NPI:1699791707
Name:KRACKE, DELYTHE JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:DELYTHE
Middle Name:JEAN
Last Name:KRACKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 VINETTA DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4011
Mailing Address - Country:US
Mailing Address - Phone:860-872-3004
Mailing Address - Fax:
Practice Address - Street 1:1075 TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1609
Practice Address - Country:US
Practice Address - Phone:860-647-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner