Healthcare Provider Details

I. General information

NPI: 1184013757
Provider Name (Legal Business Name): DIAMOND MICHELLE MICIELLI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIAMOND MICHELLE BROCKBRADER RN

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23900 MILTON ELLENDALE HWY
MILTON DE
19968-2714
US

IV. Provider business mailing address

1515 SAVANNAH RD
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-2033
  • Fax: 888-987-4302
Mailing address:
  • Phone: 302-313-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0037509
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001245
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: