Healthcare Provider Details

I. General information

NPI: 1407784002
Provider Name (Legal Business Name): JUSTINE STATEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SEDMONT CIR
SMYRNA DE
19977-1913
US

IV. Provider business mailing address

65 SEDMONT CIR
SMYRNA DE
19977-1913
US

V. Phone/Fax

Practice location:
  • Phone: 302-307-3505
  • Fax:
Mailing address:
  • Phone: 302-307-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0055668
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: