Healthcare Provider Details

I. General information

NPI: 1942581400
Provider Name (Legal Business Name): ERIN BREE WARD PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ERIN BREE BLAKELEY

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 FOX HUNT DR
BEAR DE
19701-2538
US

IV. Provider business mailing address

1010 N BANCROFT PKWY SUITE 203
WILMINGTON DE
19805-2690
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-2864
  • Fax: 302-918-3219
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-652-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLJ-0000269
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: