Healthcare Provider Details

I. General information

NPI: 1306236948
Provider Name (Legal Business Name): AMY LORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33999 W AIRPORT RD
FRANKFORD DE
19945-4070
US

IV. Provider business mailing address

33999 WEST AIRPORT RD
FRANKFORD DE
19945
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3740
  • Fax:
Mailing address:
  • Phone: 302-645-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0033123
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: