Healthcare Provider Details

I. General information

NPI: 1356629984
Provider Name (Legal Business Name): NANTICOKE WELLNESS SEAFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 8TH ST
DELMAR DE
19940-1374
US

IV. Provider business mailing address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

V. Phone/Fax

Practice location:
  • Phone: 302-846-0303
  • Fax: 302-846-0502
Mailing address:
  • Phone: 302-846-0303
  • Fax: 302-846-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS E BROWN
Title or Position: SR. VICE-PRESIDENT
Credential:
Phone: 302-629-6611