Healthcare Provider Details

I. General information

NPI: 1174872220
Provider Name (Legal Business Name): EMMANUELLA NNENNA OLAIYA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST STE 505 MOB
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

PO BOX 824804
PHILADELPHIA PA
19182-4804
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-4775
  • Fax: 302-421-4777
Mailing address:
  • Phone: 302-421-4775
  • Fax: 302-421-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberL1-0044198
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN575222
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP012353
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH-0000204
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: