Healthcare Provider Details

I. General information

NPI: 1588702732
Provider Name (Legal Business Name): ROCKEY POETA IV DC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE STE 103
NEWARK DE
19702-5703
US

IV. Provider business mailing address

35 POLARIS DR
NEWARK DE
19711-3051
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0001
  • Fax:
Mailing address:
  • Phone: 302-354-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012393
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000485
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: