Healthcare Provider Details

I. General information

NPI: 1235103292
Provider Name (Legal Business Name): MARCIA VELEET REYNOLDS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MARROWS ROAD
NEWARK DE
19713
US

IV. Provider business mailing address

2 PENNS WAY SUITE 412
NEW CASTLE DE
19720
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-322-6251
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC000326
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000350
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: