Healthcare Provider Details

I. General information

NPI: 1215456124
Provider Name (Legal Business Name): EMILY SMITH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-322-6251
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberLH-0000225
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH0000225
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: