Healthcare Provider Details

I. General information

NPI: 1578750915
Provider Name (Legal Business Name): CYNTHIA A DIEFENBECK CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA A PEARSON

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S CHAPEL ST # 102
NEWARK DE
19713-3467
US

IV. Provider business mailing address

910 S CHAPEL ST # 102
NEWARK DE
19713-3467
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax: 302-224-1402
Mailing address:
  • Phone: 302-224-1400
  • Fax: 302-224-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLE-0000143
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberLE-0000143
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: