Healthcare Provider Details

I. General information

NPI: 1750800363
Provider Name (Legal Business Name): ANDREA MARIE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

2 READS WAY STE 201
NEW CASTLE DE
19720-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 302-709-4510
  • Fax: 302-356-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18129500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: