Healthcare Provider Details

I. General information

NPI: 1124626064
Provider Name (Legal Business Name): RACHELLE LYNN DAMBMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD SUITE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD STE 531
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-733-5640
Mailing address:
  • Phone: 610-619-7475
  • Fax: 610-619-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0010822
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010822
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP022433
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0010822
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0074592
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: