Healthcare Provider Details

I. General information

NPI: 1477363281
Provider Name (Legal Business Name): KARA ANTONUCCIO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARA WALLENSTEIN

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEW ST
MIDDLETOWN DE
19709-1196
US

IV. Provider business mailing address

66 SPRING CREEK DR
TOWNSEND DE
19734-9054
US

V. Phone/Fax

Practice location:
  • Phone: 302-378-5030
  • Fax: 302-378-5080
Mailing address:
  • Phone: 732-682-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberLI-0050004
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: