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NPI Code Detail

MEDICARE: RACHEL ANN WILDMAN DELLOS DNP APRN-CNP NNP-BC

MEDICARE: RACHEL ANN WILDMAN DELLOS DNP APRN-CNP NNP-BC
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
1363LN0005XCritical Care Neonatal Nurse PractitionerAPRN.CNP.13049OH
2363LN0005XCritical Care Neonatal Nurse Practitioner24385SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APRN.CNP.13049OTHEROHOHIO APRN LICENSE
2104367549OTHERNATIONAL CERTIFYING CORPORATION
3RN.339992OTHEROHOHIO RN LICENSE
424385OTHERSCSC APRN LICENSE

General Provider Information

NPI Number : 1215208111
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL ANN WILDMAN DELLOS DNP APRN-CNP NNP-BC
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 10 MCCLENNAN BANKS DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-1164
Country : US
Telephone Number : 843-985-1569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2012
Last Update Date : 11/30/2020

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