Healthcare Provider Details

I. General information

NPI: 1770098402
Provider Name (Legal Business Name): KATHLEEN LOUISE JOINER-MARTIN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 RIVER RD
DOVER DE
19901-3753
US

IV. Provider business mailing address

151 EAST ST
MARYDEL DE
19964-2159
US

V. Phone/Fax

Practice location:
  • Phone: 302-857-5100
  • Fax: 302-857-5101
Mailing address:
  • Phone: 302-492-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0000203
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: