Basic Information
| Provider Information | |||||||||
| NPI: | 1346669850 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WILMINGTON VAMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 KIRKWOOD HWY | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198054917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029942511 | ||||||||
| FaxNumber: | 3026335339 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 KIRKWOOD HWY | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198054917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029942511 | ||||||||
| FaxNumber: | 3026335339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2014 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | BERNARDINE | ||||||||
| AuthorizedOfficialMiddleName: | CATHERINE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIABETES NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3029942511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | LG-0000180 | DE | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.