Healthcare Provider Details

I. General information

NPI: 1427868447
Provider Name (Legal Business Name): ANNETTE REGINA MANSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21635 BIDEN AVE UNIT 101
GEORGETOWN DE
19947-4575
US

IV. Provider business mailing address

1515 SAVANNAH RD
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-9596
  • Fax: 302-645-4744
Mailing address:
  • Phone: 302-645-3499
  • Fax: 302-644-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013085
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0013085
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: