Healthcare Provider Details

I. General information

NPI: 1972812360
Provider Name (Legal Business Name): LYNN DEFELICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2010
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S CENTRAL AVE LAUREL SCHOOL DISTRICT
LAUREL DE
19956-1418
US

IV. Provider business mailing address

1160 S CENTRAL AVE LAUREL SCHOOL DISTRICT
LAUREL DE
19956-1418
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-4950
  • Fax: 302-684-8931
Mailing address:
  • Phone: 302-684-4950
  • Fax: 302-684-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL10021718
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: