Healthcare Provider Details

I. General information

NPI: 1417678228
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W LEA BLVD STE 301
WILMINGTON DE
19802-2546
US

IV. Provider business mailing address

620 STANTON CHRISTIANA RD
NEWARK DE
19713-2133
US

V. Phone/Fax

Practice location:
  • Phone: 302-764-2072
  • Fax: 302-764-9347
Mailing address:
  • Phone: 302-449-7484
  • Fax: 302-327-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE THAWLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 302-449-9314