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General NPI Number Information
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NPI Number | 1124462007
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Entity Type | Individual
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Provider Name | LAYLA KIDANE
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Gender | Female
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN STANTON ROAD SUITE 5A43
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City | NEWARK
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State | DE
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Zip | 19718-2200
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Country | US
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Telephone | 302-623-0188
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Fax | 302-733-5640
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Provider Business Mailing Address
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Address Line | 3232 OAK VISTA WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-6724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010530
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN212851
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | LP-0010530
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | LP-0010530
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN212851
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License Number State | GA
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