Healthcare Provider Details

I. General information

NPI: 1609771658
Provider Name (Legal Business Name): MRS. CHANTEL ADRIENNE CHRISTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 CONCORD AVE
WILMINGTON DE
19802-3424
US

IV. Provider business mailing address

413 CONCORD AVE
WILMINGTON DE
19802-3424
US

V. Phone/Fax

Practice location:
  • Phone: 302-317-6765
  • Fax:
Mailing address:
  • Phone: 302-317-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBH008617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: