Provider Demographics
NPI:1982971081
Name:DELACRUZ, NINA
Entity type:Individual
Prefix:MISS
First Name:NINA
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 876157
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6157
Mailing Address - Country:US
Mailing Address - Phone:907-315-6046
Mailing Address - Fax:
Practice Address - Street 1:1453 W KANABEC DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9748
Practice Address - Country:US
Practice Address - Phone:907-315-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator