Provider Demographics
NPI:1174032775
Name:GATHURA, JANE WANJIRU (FNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:WANJIRU
Last Name:GATHURA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 E PEMBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4002
Mailing Address - Country:US
Mailing Address - Phone:302-480-5042
Mailing Address - Fax:
Practice Address - Street 1:1601 MILLTOWN RD STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4047
Practice Address - Country:US
Practice Address - Phone:302-543-6165
Practice Address - Fax:302-543-6130
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001065363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty