Healthcare Provider Details

I. General information

NPI: 1255143392
Provider Name (Legal Business Name): ANGELINE WLOCK MSN, AGPCNP-C, CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E LOOCKERMAN ST STE 200
DOVER DE
19901-3779
US

IV. Provider business mailing address

1361 DEXTER CORNER RD
TOWNSEND DE
19734-9245
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP031933
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010861
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: