Healthcare Provider Details

I. General information

NPI: 1457711517
Provider Name (Legal Business Name): KIMBERLY WHITT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 110
DOVER DE
19904-3486
US

IV. Provider business mailing address

406 ANN MOORE ST
DOVER DE
19904-4002
US

V. Phone/Fax

Practice location:
  • Phone: 302-346-4000
  • Fax:
Mailing address:
  • Phone: 302-222-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberL1-0022626
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: