Provider Demographics
NPI:1538264130
Name:BACKS, DELMA I (ARNPC)
Entity type:Individual
Prefix:
First Name:DELMA
Middle Name:I
Last Name:BACKS
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1361
Mailing Address - Country:US
Mailing Address - Phone:785-842-8645
Mailing Address - Fax:785-842-8645
Practice Address - Street 1:404 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1361
Practice Address - Country:US
Practice Address - Phone:785-842-3635
Practice Address - Fax:785-842-8645
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44518363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100332920AMedicaid
KS100332920AMedicaid
KS160206Medicare ID - Type Unspecified