Healthcare Provider Details

I. General information

NPI: 1568128890
Provider Name (Legal Business Name): MLEANEN MARCIA GILMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/28/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E PULASKI HWY
ELKTON MD
21921-6037
US

IV. Provider business mailing address

141 EDGAR RD
TOWNSEND DE
19734-2417
US

V. Phone/Fax

Practice location:
  • Phone: 302-595-3670
  • Fax:
Mailing address:
  • Phone: 302-464-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPO24714
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC004580
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0011814
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: