Individual provider Active NPI

Delayna A Nitz, N.P.

  • Nurse Practitioner
  • Cass Lake, MN
National Provider Identifier
1780662544
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R-170159-9 Issued in MN
Practice address
425 7TH St NW
Cass Lake, MN 56633-3360
Phone
(218) 335-3200
NPI assigned
Jan 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R-170159-9 MN Primary

Addresses

Primary practice location

425 7TH St NW
Cass Lake, MN 56633-3360

Mailing address

425 7TH St NW
Cass Lake, MN 56633-3360
Phone (218) 335-3200

Other identifiers 1

IdentifierTypeStateIssuer
421495100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051116000991 MN Practitioner - Nurse Practitioner 3971522160 Reassigns benefits to 1 organization
I20220304001606 TX Practitioner - Nurse Practitioner 3971522160 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

425 7TH St NW
Cass Lake, MN 56633-3360

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R-170159-9MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Health & Human Services PHS IHS CurrentSince Feb 14, 2022 Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Oct 14, 2015 Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

350 E Devon Ave
Itasca, IL 60143

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1705 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2035

425 7th St NW
Cass Lake, MN 56633
Phone (218) 335-3200

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1780662544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 7TH ST NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333360",
            "telephone_number": "218-335-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 7TH ST NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333360",
            "telephone_number": "218-335-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NITZ",
        "first_name": "DELAYNA",
        "middle_name": "A",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R-170159-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421495100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cass Lake, MN

Sources for this page

Verify at the official NPI Registry.