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General NPI Number Information
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NPI Number | 1558074286
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Entity Type | Individual
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Provider Name | WADVENS DORELUS D4G9H6Y6
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Gender | Male
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 421 W 30TH ST MOBILIZE
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City | RIVIERA BEACH
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-568-6646
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W 30TH ST MOBILIZE
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City | RIVIERA BEACH
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-568-6646
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | D4G9H6Y6
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License Number State |
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Taxonomy #6
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | D4G9H6Y6
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | D4G9H6Y6
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License Number State | FL
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