Healthcare Provider Details

I. General information

NPI: 1700101938
Provider Name (Legal Business Name): JENNETTE A FIRLEIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNETTE A WIKEL APN

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD NEMOURS CHILDRENS CLINIC
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-5600
  • Fax: 302-651-5612
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberLJ-0000255
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL10034230
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ0000255
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: