Healthcare Provider Details

I. General information

NPI: 1174032775
Provider Name (Legal Business Name): JANE WANJIRU GATHURA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MILLTOWN RD STE 2
WILMINGTON DE
19808-4047
US

IV. Provider business mailing address

196 E PEMBROOKE DR
SMYRNA DE
19977-4002
US

V. Phone/Fax

Practice location:
  • Phone: 302-543-6165
  • Fax: 302-543-6130
Mailing address:
  • Phone: 302-480-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberLG-0001065
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001065
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: