Healthcare Provider Details

I. General information

NPI: 1124357454
Provider Name (Legal Business Name): LAUREN G GILLESPIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD DIV. OF EMERGENCY MEDICINE
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1600 ROCKLAND RD DIV. OF EMERGENCY MEDICINE
WILMINGTON DE
19803-3607
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4296
  • Fax: 302-651-4227
Mailing address:
  • Phone: 302-651-4296
  • Fax: 302-651-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000695
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: