Healthcare Provider Details

I. General information

NPI: 1386457976
Provider Name (Legal Business Name): KATRIYAH YISRAEL BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W 18TH ST
WILMINGTON DE
19802-4835
US

IV. Provider business mailing address

125 W 18TH ST
WILMINGTON DE
19802-4835
US

V. Phone/Fax

Practice location:
  • Phone: 302-650-2021
  • Fax:
Mailing address:
  • Phone: 302-650-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberL1-0040132
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number2025701170
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0040132
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: