Healthcare Provider Details

I. General information

NPI: 1508356577
Provider Name (Legal Business Name): JULIE CHRISTINE LANDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

6 GUMWOOD DR
WILMINGTON DE
19803-4001
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-4333
  • Fax:
Mailing address:
  • Phone: 973-713-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001239
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: