Healthcare Provider Details

I. General information

NPI: 1124313887
Provider Name (Legal Business Name): DEBORAH M BLACK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD CHRISTIANA HOSPITAL, SUITE 1E1070
NEWARK DE
19718-0001
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD CHRISTIANA HOSPITAL, SUITE 1E10
NEWARK DE
19718-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1487
  • Fax:
Mailing address:
  • Phone: 302-733-1487
  • Fax: 302-733-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000556
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000556
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: