Healthcare Provider Details

I. General information

NPI: 1558294942
Provider Name (Legal Business Name): JULIA WUTHNOW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 106
NEWARK DE
19713-2154
US

IV. Provider business mailing address

2400 PINE AVE
WILMINGTON DE
19808-3230
US

V. Phone/Fax

Practice location:
  • Phone: 302-999-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013707
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: