Basic Information
| Provider Information | |||||||||
| NPI: | 1922079631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOWER-WADE | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30170 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198057170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234370 | ||||||||
| FaxNumber: | 3026234375 | ||||||||
| Practice Location | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE129 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234370 | ||||||||
| FaxNumber: | 3026234375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 05/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L1-0016450 | DE | N | Nursing Service Providers | Registered Nurse | 364SA2200X | LN-0000111 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 364SC0200X | LN-0000111 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Critical Care Medicine | 364SN0800X | LN-0000111 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Neuroscience |
No ID Information.