Healthcare Provider Details

I. General information

NPI: 1922079631
Provider Name (Legal Business Name): DONNA MOWER-WADE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE129
NEWARK DE
19713-2067
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone: 302-623-4370
  • Fax: 302-623-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0016450
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberLN-0000111
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberLN-0000111
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License NumberLN-0000111
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: