Healthcare Provider Details

I. General information

NPI: 1114629060
Provider Name (Legal Business Name): NICOLE KUSHNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 YORKLYN RD STE 100
HOCKESSIN DE
19707-8745
US

IV. Provider business mailing address

726 YORKLYN RD STE 100
HOCKESSIN DE
19707-8745
US

V. Phone/Fax

Practice location:
  • Phone: 302-234-5770
  • Fax: 302-234-5777
Mailing address:
  • Phone: 302-234-5770
  • Fax: 302-234-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0024954
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: