Healthcare Provider Details

I. General information

NPI: 1700797073
Provider Name (Legal Business Name): MARTHA NIZIOLEK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEUROLOGY WAY
MILFORD DE
19963-5368
US

IV. Provider business mailing address

111 NEUROLOGY WAY
MILFORD DE
19963-5368
US

V. Phone/Fax

Practice location:
  • Phone: 302-315-4011
  • Fax: 302-231-7743
Mailing address:
  • Phone: 302-315-4011
  • Fax: 302-231-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013941
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: