=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679916522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIANA CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 N WASHINGTON ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19801-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-304-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 120
-----------------------------------------------------
City | CHESTER HEIGHTS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. DANA D CORTESE
-----------------------------------------------------
Credential | APN
-----------------------------------------------------
Telephone | 610-304-6437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | LG-0000650
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------