Provider Demographics
NPI:1427215946
Name:DEUBER, CHARLENE MILTZ (APRN)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MILTZ
Last Name:DEUBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:MILTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4200
Practice Address - Fax:302-651-5458
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0048332363L00000X
DELM-0000164364SN0000X
DELM0000164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0349933Medicaid
MD6599109-00Medicaid