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General NPI Number Information
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NPI Number | 1477365856
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Entity Type | Organization
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Legal Business Name | MICA RAE, LLC.
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 705 E STATE ST
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City | DELMAR
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State | DE
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Zip | 19940-1347
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Country | US
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Telephone | 302-212-7994
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Fax | 866-635-3408
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Provider Business Mailing Address
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Address Line | 705 E STATE ST
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City | DELMAR
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State | DE
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Zip | 19940-1347
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Country | US
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Telephone | 302-212-7994
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Fax | 866-635-3408
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. MICA GOEHNER
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Credential | FNP-C
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Telephone | 302-212-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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