Organization
IVPS OF DELAWARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEANE WAKULA (OFFICE MANAGER)
(772) 546-9591
Entity
Organization
Contact information
Practice address
1305 KIRKWOOD HIGHWAY, WILMINGTON, DE 19805
(302) 994-6575
Mailing address
8929 SE BRIDGE ROAD, HOBE SOUND, FL 33455
(772) 546-9591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C2-0010908
DE
Other
Enumeration date
01/27/2016
Last updated
01/27/2016
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