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General NPI Number Information
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NPI Number | 1396508990
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Entity Type | Individual
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Provider Name | GINGER RENEE WILLE CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 9950 MAIN ST
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City | BERLIN
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State | MD
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Zip | 21811-3281
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Country | US
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Telephone | 443-668-2563
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Fax |
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Provider Business Mailing Address
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Address Line | 31775 DUANE DR
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City | FRANKFORD
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State | DE
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Zip | 19945-2828
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Country | US
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Telephone | 144-366-8256
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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 | LG-0012606
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AC006237
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License Number State | MD
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