Healthcare Provider Details

I. General information

NPI: 1215108881
Provider Name (Legal Business Name): DELZINA WYNNE-GAINES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 AFTON CT
NEW CASTLE DE
19720-4401
US

IV. Provider business mailing address

109 AFTON CT
NEW CASTLE DE
19720-4401
US

V. Phone/Fax

Practice location:
  • Phone: 302-276-1836
  • Fax:
Mailing address:
  • Phone: 302-276-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0036222
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: