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NPI Code Detail

MEDICARE: MRS. AMANDA BERKEBILE WAINWRIGHT NP- C

MEDICARE: MRS. AMANDA BERKEBILE WAINWRIGHT NP- C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerLG-0000780DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LG-0000780OTHERDESTATE LICENSE
2R181844OTHERMDSTATE LICENSE

General Provider Information

NPI Number : 1174923015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA BERKEBILE WAINWRIGHT NP- C
Provider Business Mailing Address
First Line : 32427 LIGHTHOUSE RD
Second Line :
City : SELBYVILLE
State : DE
Zip : 19975-3408
Country : US
Telephone Number : 443-424-6131
Fax Number : 302-616-0003
Provider Business Practice Location Address
First Line : 32427 LIGHTHOUSE RD
Second Line :
City : SELBYVILLE
State : DE
Zip : 19975-3408
Country : US
Telephone Number : 443-424-6131
Fax Number : 302-616-0003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2014
Last Update Date : 07/08/2021

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