Healthcare Provider Details

I. General information

NPI: 1538555008
Provider Name (Legal Business Name): HEATHER PANICHELLI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 04/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

410 DRAPER LN
MIDDLETOWN DE
19709-8018
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 703-946-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberLV-0000107
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: