Healthcare Provider Details

I. General information

NPI: 1780108332
Provider Name (Legal Business Name): EMILY KOJRO DUSZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

26 GLENBARRY DR
WILMINGTON DE
19808-1365
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3300
  • Fax:
Mailing address:
  • Phone: 302-598-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberL1-0048628
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: