Provider Demographics
NPI:1043524499
Name:DELOZIER, M DANIELLE (PNP-BC)
Entity type:Individual
Prefix:
First Name:M
Middle Name:DANIELLE
Last Name:DELOZIER
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DANIELLE
Other - Last Name:DELOZIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP-BC
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3000
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025834363LP0200X
KS53-75150-102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics