Healthcare Provider Details

I. General information

NPI: 1730188467
Provider Name (Legal Business Name): BEATRICE M GAYNOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N COLLEGE AVE
NEWARK DE
19716-3799
US

IV. Provider business mailing address

1275S STATE ST
DOVER DE
19901-6927
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-3195
  • Fax: 302-831-3193
Mailing address:
  • Phone: 302-672-2319
  • Fax: 302-672-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG0000166
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: