Healthcare Provider Details

I. General information

NPI: 1801820592
Provider Name (Legal Business Name): THERESA JOAN INERFIELD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 PHILADELPHIA PIKE
CLAYMONT DE
19703-2508
US

IV. Provider business mailing address

80 AVIGNON DR
NEWARK DE
19702-5522
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-8000
  • Fax: 302-798-3399
Mailing address:
  • Phone: 302-832-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH0000177
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: