Healthcare Provider Details

I. General information

NPI: 1437547106
Provider Name (Legal Business Name): JENNIFER GICK CALLARD MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 DUPONT BLVD 101
GEORGETOWN DE
19947-1725
US

IV. Provider business mailing address

20930 DUPONT BLVD. 101
GEORGETOWN DE
19947
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-3737
  • Fax:
Mailing address:
  • Phone: 302-856-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0034751
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000917
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: