Individual
SERA NA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 ROCKLAND RD, WILMINGTON, DE 19803-3607
(267) 992-0625
Mailing address
1600 ARCH ST APT 815, PHILADELPHIA, PA 19103-2008
(267) 992-0625
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C7-0007320
DE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2017
Last updated
07/20/2020
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