Provider Demographics
NPI:1417961228
Name:GAINES-DILLARD, NANCY LEE (DNP, APRN-BC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:GAINES-DILLARD
Suffix:
Gender:F
Credentials:DNP, APRN-BC
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:GAINES-DILLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, APRN-BC
Mailing Address - Street 1:P.O. BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-623-7200
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:4735 OGLETOWN STANTON ROAD
Practice Address - Street 2:SUITE 3301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-753-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000944363LF0000X, 363LA2100X
PASP007766363LF0000X, 363LA2100X
DELG0000509363LF0000X, 363LA2100X
AZAP8274363LA2100X
WAAP60683716363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily