Provider Demographics
NPI:1831586791
Name:DELVA, ROSE MICHELLE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MICHELLE
Last Name:DELVA
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 1:125 RIVERLOOK ML
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-4940
Mailing Address - Country:US
Mailing Address - Phone:404-600-3300
Mailing Address - Fax:678-817-4898
Practice Address - Street 1:125 RIVERLOOK ML
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4940
Practice Address - Country:US
Practice Address - Phone:404-600-3300
Practice Address - Fax:678-817-4898
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily