Healthcare Provider Details

I. General information

NPI: 1780308338
Provider Name (Legal Business Name): KATHLEEN MARY DEALY ACCNS-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN LUCKNER

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD # 3E29
NEWARK DE
19718-2200
US

IV. Provider business mailing address

719 JAMESTOWN WAY
WEST CHESTER PA
19380-6486
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-7453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0048950
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberLV-0010137
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: