Provider Demographics
NPI:1215208111
Name:WILDMAN DELLOS, RACHEL ANN (DNP APRN-CNP NNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:WILDMAN DELLOS
Suffix:
Gender:F
Credentials:DNP APRN-CNP NNP-BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:WILDMAN-DELLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:10 MCCLENNAN BANKS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1164
Practice Address - Country:US
Practice Address - Phone:843-985-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13049363LN0005X
SC24385363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.13049OtherOHIO APRN LICENSE
104367549OtherNATIONAL CERTIFYING CORPORATION
OHRN.339992OtherOHIO RN LICENSE
SC24385OtherSC APRN LICENSE