Healthcare Provider Details

I. General information

NPI: 1477902575
Provider Name (Legal Business Name): CHRISTIE WHITLOCK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18068 COASTAL HWY
LEWES DE
19958-4901
US

IV. Provider business mailing address

20251 JOHN J WILLIAMS HWY
LEWES DE
19958-4314
US

V. Phone/Fax

Practice location:
  • Phone: 302-567-1500
  • Fax:
Mailing address:
  • Phone: 302-644-6860
  • Fax: 302-644-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0043083
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001288
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: