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General NPI Number Information
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NPI Number | 1245033208
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Entity Type | Organization
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Legal Business Name | OASIS FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2600 GLASGOW AVE STE 104
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City | NEWARK
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State | DE
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Zip | 19702-5703
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Country | US
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Telephone | 302-770-0030
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Fax | 302-273-0031
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Provider Business Mailing Address
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Address Line | 2600 GLASGOW AVE STE 104
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City | NEWARK
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State | DE
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Zip | 19702-5703
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Country | US
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Telephone | 302-770-0030
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Fax | 302-273-0031
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Authorized Official
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Title or Position | CEO
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Name | MBWIDIFFU DIBAL
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Credential | CRNP, FNP
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Telephone | 302-770-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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