Healthcare Provider Details

I. General information

NPI: 1508691619
Provider Name (Legal Business Name): DYNESHA KERKULA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

29 W RADISON RUN
CLAYTON DE
19938-3830
US

V. Phone/Fax

Practice location:
  • Phone: 302-661-3070
  • Fax: 302-320-7327
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberL1-0050582
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: