Healthcare Provider Details

I. General information

NPI: 1609219286
Provider Name (Legal Business Name): ANNMARIE FENTON-KOWRACH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/17/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 BAY ROAD, UNIT C
DOVER DE
19963
US

IV. Provider business mailing address

665 S BAY ROAD UNIT C
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-1303
  • Fax: 302-430-5679
Mailing address:
  • Phone: 302-672-2319
  • Fax: 302-672-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberLG-0000656
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code364SX0106X
TaxonomyOccupational Health Clinical Nurse Specialist
License NumberLG-0000656
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000656
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: