Healthcare Provider Details

I. General information

NPI: 1801528211
Provider Name (Legal Business Name): FAWN RENEA WATKINSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR
NEWARK DE
19713-2049
US

IV. Provider business mailing address

4601 S DUPONT HWY STE 2
DOVER DE
19901-6405
US

V. Phone/Fax

Practice location:
  • Phone: 302-273-1701
  • Fax: 302-273-4497
Mailing address:
  • Phone: 302-698-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0052382
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0012050
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012050
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC006854
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC006854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: