Healthcare Provider Details

I. General information

NPI: 1467711952
Provider Name (Legal Business Name): MAYUMI LEA ANTHONY-GUBITOSI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD STE 109
NEWARK DE
19713-4248
US

IV. Provider business mailing address

774 CHRISTIANA RD STE 109
NEWARK DE
19713-4248
US

V. Phone/Fax

Practice location:
  • Phone: 302-444-8156
  • Fax: 302-731-8158
Mailing address:
  • Phone: 302-444-8156
  • Fax: 302-731-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLB-0000249
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: