| NPI | 1114648920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROCHELLE THAWLEY Credentialing Specialist 302-449-9314 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2023-03-15 |