Provider Demographics
NPI:1003223355
Name:DELCORVO, JESSICA MARY (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARY
Last Name:DELCORVO
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-9650
Mailing Address - Fax:517-364-9605
Practice Address - Street 1:1140 E MICHIGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-9650
Practice Address - Fax:517-364-9605
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2019-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704264695363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care