Provider Demographics
NPI:1417665241
Name:CHEF WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:CHEF WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:302-238-6200
Mailing Address - Street 1:200 CONTINENTAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4337
Mailing Address - Country:US
Mailing Address - Phone:302-238-6200
Mailing Address - Fax:
Practice Address - Street 1:200 CONTINENTAL DR STE 401
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4337
Practice Address - Country:US
Practice Address - Phone:302-238-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty