Provider Demographics
NPI:1447886692
Name:CROFF, DELPHIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DELPHIA
Middle Name:
Last Name:CROFF
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 8243
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49518-8243
Mailing Address - Country:US
Mailing Address - Phone:616-299-3850
Mailing Address - Fax:
Practice Address - Street 1:3427 FARR RD STE B
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-8854
Practice Address - Country:US
Practice Address - Phone:231-865-1625
Practice Address - Fax:231-865-6212
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234637363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care