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NPI Code Detail

MEDICARE: WAINWRIGHT DIRECT PRIMARY CARE LLC

MEDICARE: WAINWRIGHT DIRECT PRIMARY CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1215493093
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAINWRIGHT DIRECT PRIMARY CARE LLC
Provider Business Mailing Address
First Line : 32427 LIGHTHOUSE RD
Second Line :
City : SELBYVILLE
State : DE
Zip : 19975-3408
Country : US
Telephone Number : 443-424-6131
Fax Number : 302-616-0003
Provider Business Practice Location Address
First Line : 32427 LIGHTHOUSE RD
Second Line :
City : SELBYVILLE
State : DE
Zip : 19975-3408
Country : US
Telephone Number : 443-783-0153
Fax Number :
Authorized Official
Title or Position : OWNER/ PROVIDER
Name : MRS. AMANDA BERKEBILE WAINWRIGHT
Credential : NURSE PRACTITIONER
Telephone Number : 443-424-6131
Provider Enumeration Date : 02/15/2019
Last Update Date : 07/08/2021

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Directions to “WAINWRIGHT DIRECT PRIMARY CARE LLC ” Practice Location

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