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General NPI Number Information
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NPI Number | 1629709050
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Entity Type | Individual
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Provider Name | CHRISTINA MINISSALE
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 18068 COASTAL HWY
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City | LEWES
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State | DE
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Zip | 19958-4901
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Country | US
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Telephone | 302-567-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 502 LEE ANN RD
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1338
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Country | US
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Telephone | 215-622-7143
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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 | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 207PP0204X
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | LJ-0010514
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License Number State | DE
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