Healthcare Provider Details

I. General information

NPI: 1245598846
Provider Name (Legal Business Name): MELVIS E NGALLA-OLUKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELVIS E NGALLA

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST STE 1E30
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST STE 1E30
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-9660
  • Fax: 302-320-9665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0047893
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL8-0000189
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0000189
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: