Healthcare Provider Details

I. General information

NPI: 1538094172
Provider Name (Legal Business Name): VITALCORE WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 ELIASON DR
MIDDLETOWN DE
19709-3311
US

IV. Provider business mailing address

218 ELIASON DR
MIDDLETOWN DE
19709-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-389-8697
  • Fax:
Mailing address:
  • Phone: 610-389-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS RAQUEL CASSANDRA REID
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APRN
Phone: 610-389-8697