Healthcare Provider Details

I. General information

NPI: 1730626755
Provider Name (Legal Business Name): MICHELE TJADEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 AMERICAN BLVD
BEAR DE
19701-4932
US

IV. Provider business mailing address

301 AMERICAN BLVD
BEAR DE
19701-4932
US

V. Phone/Fax

Practice location:
  • Phone: 302-334-8988
  • Fax: 833-428-3858
Mailing address:
  • Phone: 302-334-8988
  • Fax: 833-428-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001007
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: