Healthcare Provider Details

I. General information

NPI: 1437612876
Provider Name (Legal Business Name): AMANDA ELIZABETH WILLIAMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 2E99
NEWARK DE
19718-2049
US

IV. Provider business mailing address

66 GREENRIDGE RD
NEWARK DE
19711-6735
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-3017
  • Fax:
Mailing address:
  • Phone: 302-824-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0040031
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001202
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: