Healthcare Provider Details

I. General information

NPI: 1912238585
Provider Name (Legal Business Name): STEPHANIE CLARE MELLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 12/05/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 CEDAR LANE RD
MIDDLETOWN DE
19709-9636
US

IV. Provider business mailing address

PO BOX 4010 313 SOUTH FIFTH STREET
ODESSA DE
19730-4010
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-5878
  • Fax: 302-378-5139
Mailing address:
  • Phone: 302-376-4128
  • Fax: 302-378-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0025967
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: