Healthcare Provider Details

I. General information

NPI: 1972427011
Provider Name (Legal Business Name): ANDREA GUNDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N HARRISON ST APT 1401
WILMINGTON DE
19806-3170
US

IV. Provider business mailing address

1301 N HARRISON ST APT 1401
WILMINGTON DE
19806-3170
US

V. Phone/Fax

Practice location:
  • Phone: 610-675-7432
  • Fax:
Mailing address:
  • Phone: 610-675-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberL1-0054026
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: