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Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Pediatrics

Provider NPI: 1831228147

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 302-651-4200  Fax: 302-651-4193

Business Mailing Address:
PO BOX 191  ROCKLAND, DE 19732-0191 US
Tel: 302-651-4000  Fax: 302-651-4945

NPI Information:
NPI: 1831228147
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
N363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363L00000X





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