Healthcare Provider Details

I. General information

NPI: 1881638567
Provider Name (Legal Business Name): CAROLYN C. WEEKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR
NEWARK DE
19713-2049
US

IV. Provider business mailing address

200 HYGEIA DR
NEWARK DE
19713-2049
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000269
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: