Healthcare Provider Details

I. General information

NPI: 1679221915
Provider Name (Legal Business Name): DECARLA PEARSALL BSN, RN, CMDCP, CGCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 WILMINGTON RD STE F
HISTORIC NEW CASTLE DE
19720-3685
US

IV. Provider business mailing address

548 CONCORD BRIDGE PL
NEWARK DE
19702-5264
US

V. Phone/Fax

Practice location:
  • Phone: 302-213-0477
  • Fax:
Mailing address:
  • Phone: 302-213-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberL1-0037155
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberL1-0037155
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0037155
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: