Healthcare Provider Details

I. General information

NPI: 1255571998
Provider Name (Legal Business Name): CAROLE MENZEL BREITKREITZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 170
DOVER DE
19904-3485
US

IV. Provider business mailing address

PO BOX 67537
NEWARK NJ
07101-8009
US

V. Phone/Fax

Practice location:
  • Phone: 302-400-9999
  • Fax: 302-487-1167
Mailing address:
  • Phone: 302-400-9999
  • Fax: 302-267-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000484
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: