Healthcare Provider Details

I. General information

NPI: 1700056223
Provider Name (Legal Business Name): GAYNEL FONTAINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAYNEL DANIEL

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 GLASGOW AVENUE HODGSON VO TECH
NEWARK DE
19702
US

IV. Provider business mailing address

200 HYGEIA DRIVE SUITE 2300
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-5400
  • Fax: 302-832-5407
Mailing address:
  • Phone: 302-655-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL10031608
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000530
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: