Healthcare Provider Details

I. General information

NPI: 1184369936
Provider Name (Legal Business Name): HOLISTIC FAMILY MEDICAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 CHAPMAN RD STE 107
NEWARK DE
19702-5412
US

IV. Provider business mailing address

44 PRINCETON CT
NEWARK DE
19702-5211
US

V. Phone/Fax

Practice location:
  • Phone: 302-685-2222
  • Fax: 302-355-1198
Mailing address:
  • Phone: 267-879-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. FANTA SCHWARZ
Title or Position: PROVIDER/OWNER
Credential: FNP
Phone: 267-879-6292