Healthcare Provider Details

I. General information

NPI: 1811477300
Provider Name (Legal Business Name): HARLEY ELIZABETH WILLIAMS LUBATTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HARLEY WILLIAMS

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 250
DOVER DE
19904-3492
US

IV. Provider business mailing address

200 BANNING ST STE 250
DOVER DE
19904-3492
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-1320
  • Fax: 302-346-4532
Mailing address:
  • Phone: 302-736-1320
  • Fax: 302-346-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060015
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA060015
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011766
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: